護理師正在指導一位因高血壓開始服用 spironolactone 的病患。護理師應建議病患避免哪種飲食選擇？
The nurse is educating a client starting spironolactone for hypertension. Which dietary choice should the nurse advise the client to avoid?
- ASalt substitutes✓ 正解鹽巴替代品
- BLeafy green vegetables葉菜類蔬菜
- CDairy products乳製品
- DCanned tuna罐頭鮪魚
Spironolactone 的藥理核心是保鉀利尿劑。為何 A 正確：市售的代鹽（Salt substitutes）通常將鈉離子替換為鉀離子，對於服用保鉀利尿劑的病人來說，攝取代鹽會導致血鉀快速升高，增加高血鉀症及致命性心律不整的風險。為何其他選項錯：A（深綠色蔬菜）富含維生素 K，主要影響 Warfarin。C（乳製品）主要影響鈣磷平衡。D（罐裝鮪魚）含鈉較高，高血壓患者應限制，但不如代鹽對保鉀利尿劑的直接威脅大。臨床思路：用藥安全在於辨識藥物與飲食的隱藏互動，病人常以為「低鈉鹽」健康，護理師必須明確指出其潛在風險。
Spironolactone is pharmacologically a potassium-sparing diuretic. Why A is correct: commercially available salt substitutes typically replace sodium with potassium, so for clients taking a potassium-sparing diuretic, intake of salt substitutes will rapidly raise serum potassium, increasing the risk of hyperkalemia and fatal arrhythmias. Why the other options are wrong: A (dark leafy greens) are rich in vitamin K, which mainly affects warfarin. C (dairy products) primarily affects calcium-phosphorus balance. D (canned tuna) is high in sodium and should be limited by hypertensive clients, but it does not pose as direct a threat with potassium-sparing diuretics as salt substitutes do. Clinical reasoning: medication safety lies in identifying hidden interactions between drugs and diet. Clients often assume 'low-sodium salt' is healthy, and the nurse must clearly point out its potential risks.
美國 NCLEX 題目中「Salt substitutes = Potassium」是標準考點；台灣病患常用的「低鈉鹽」或「健康鹽」成分標示有時不明顯，護理師需教導病患閱讀包裝標示中的「鉀」含量，這點與美國衛教重點一致但產品名稱略異。