一位第一型糖尿病病人被發現意識喪失且皮膚濕冷。手指血糖值為 42 mg/dL。病人已建立靜脈（IV）管路。護理師應優先給予哪種藥物？
A client with type 1 diabetes mellitus is found unconscious and clammy. The fingerstick glucose is 42 mg/dL. The client has an intravenous (IV) line in place. Which medication should the nurse administer first?
- AOral glucose gel between the cheek and gum將口服葡萄糖凝膠置於頰齒之間
- B50% Dextrose (D50W) intravenous push✓ 正解靜脈推注 50% 葡萄糖溶液 (D50W)
- CRegular insulin 10 units subcutaneously皮下注射 10 單位常規胰島素
- DGlucagon 1 mg intramuscularly (IM)肌肉注射 1 mg 升糖素
這題考的是嚴重低血糖（<70 mg/dL 且有意識改變）的緊急處置路徑。當病人意識喪失且「已有靜脈管路」時，靜脈推注 50% 葡萄糖（D50W）是起效最快且最安全的首選。A 選項（口服凝膠）絕對禁忌，因為病人無意識，極易造成吸入性肺炎。D 選項（升糖素肌肉注射）是在「沒有靜脈管路」時的替代方案，但在有 IV 時應選 D50W。C 選項（胰島素）會使低血糖更嚴重，是致命錯誤。護理思路應為：最快路徑 + 預防吸入風險。
This question tests the emergency management pathway for severe hypoglycemia (<70 mg/dL with altered mental status). When the client is unconscious and an IV line is already in place, intravenous push of 50% dextrose (D50W) is the fastest-acting and safest first-line choice. Option A (oral gel) is absolutely contraindicated because the client is unconscious and at extreme risk of aspiration pneumonia. Option D (intramuscular glucagon) is the alternative when no IV access is available; however, when an IV is present, D50W is preferred. Option C (insulin) would worsen hypoglycemia and constitutes a fatal error. The nursing rationale should be: fastest route plus prevention of aspiration risk.
美國 NCLEX 強調有 IV 就用 D50W，沒 IV 才用 Glucagon；台灣臨床實務上，部分病房即便有 IV 也可能先找 Glucagon（若 D50W 未備於急救車），但在標準考試中必須優先選靜脈路徑。