一位患有慢性腎臟病（CKD）的病人預定進行靜脈腎盂造影（IVP）。護理師在檢查前最優先執行的措施為何？
A client with a history of chronic kidney disease (CKD) is scheduled for an intravenous pyelogram (IVP). Which action is most important for the nurse to perform prior to the procedure?
- AAssess the client for a history of hypertension評估客戶是否有高血壓病史
- BAdminister a prescribed laxative the evening before前一晚給予處方瀉藥
- CInstruct the client to remain NPO for 12 hours指示客戶禁食 12 小時
- DReview the client's baseline creatinine level✓ 正解檢視客戶的基線肌酸酐值
靜脈腎盂造影（IVP）涉及使用碘顯影劑，這對腎功能受損的病人具有極高的顯影劑誘發性腎病（CIN）風險。核心概念是評估器官對診斷性檢查的耐受度。對於 CKD 病人，基線肌酸酐（Creatinine）和腎絲球過濾率（eGFR）是決定是否能安全施打顯影劑的關鍵指標。護理師的臨床思路必須放在「減少風險潛能」上，即在暴露於危險因子（顯影劑）之前，先確認病人的易感狀態。雖然 NPO（C）和清腸（B）是 IVP 的標準準備步驟（為了讓影像更清晰），但在安全原則下，預防急性腎損傷（AKI）的重要性遠高於影像品質。如果肌酸酐過高，護理師必須主動與醫療團隊溝通，考慮取消檢查或採取預防性補液措施。高血壓（A）雖與 CKD 相關，但不是 IVP 檢查前的直接禁忌評估重點。
Intravenous pyelography (IVP) requires the use of iodinated contrast medium, which poses a very high risk of contrast-induced nephropathy (CIN) in patients with impaired renal function. The core concept is to assess an organ's tolerance to a diagnostic test. For patients with chronic kidney disease (CKD), baseline creatinine and estimated glomerular filtration rate (eGFR) are the key indicators for deciding whether contrast can be safely administered. The nurse's clinical reasoning must focus on "reducing risk potential"—that is, confirming the patient's susceptibility before exposure to the harmful agent (contrast). Although NPO status (C) and bowel cleansing (B) are standard preparations for IVP (to ensure clearer imaging), under the principle of safety, prevention of acute kidney injury (AKI) is far more important than image quality. If creatinine is too high, the nurse must proactively communicate with the medical team to consider canceling the test or instituting prophylactic hydration. Hypertension (A), although associated with CKD, is not the direct contraindication-related focus of pre-IVP assessment.
在美國，顯影劑安全檢查表（Contrast Safety Checklist）是由 RN 獨立核對的關鍵流程，若 Creatinine 超標，RN 有權暫緩檢查。在台灣，此類評估通常由放射科醫師與病房醫師共同決定，但護理師仍需負擔提醒與初步篩檢的責任。