— 生理適應 · HARD · MCQ —
一名 55 歲高血壓病史病人主訴頭痛、視力模糊與噁心，血壓 210/130 mmHg。下列何者為護理師的首要措施？
A 55-year-old client with a history of hypertension reports severe headache, blurred vision, and nausea. Blood pressure is 210/130 mmHg. Which action is the priority?
- AObtain an EKG and cardiac enzymes進行心電圖檢查並檢測心肌酵素
- BReduce blood pressure gradually with IV vasodilator✓ 正解使用靜脈血管擴張劑逐漸降低血壓
- CMonitor the client's neurological status hourly每小時監測病人的神經學狀態
- DAdminister an oral antihypertensive medication給予口服降血壓藥物
— Explanation · 中文詳解 —
此為高血壓急症（Hypertensive Emergency）。目標為在一小時內將平均動脈壓降低不超過 25%，過快降壓可能導致臟器缺血。靜脈注射血管擴張劑能精確控制血壓，是臨床處置的首選，口服藥物吸收速度太慢且不可預測。
This is a Hypertensive Emergency. The goal is to lower the mean arterial pressure by no more than 25% within the first hour, since lowering blood pressure too quickly can cause organ ischemia. IV vasodilators allow precise control of blood pressure and are the first-line clinical management. Oral medications have an absorption that is too slow and unpredictable.
✦ 台美臨床差異
美國重症單位（ICU）常使用 Nicardipine 或 Labetalol 滴注；台灣在急診或 ICU 亦有類似規範，但給藥路徑可能受限於藥品庫存。