一位診斷為嗜鉻細胞瘤的病人入院，血壓為 210/110 mmHg。護理師應優先執行哪項措施？
A client is admitted with a diagnosis of Pheochromocytoma. The client's blood pressure is 210/110 mmHg. Which action is the priority for the nurse to implement?
- AAdminister a prescribed alpha-adrenergic blocker✓ 正解給予處方之 alpha-腎上腺素阻斷劑
- BAdminister a prescribed beta-blocker給予處方之 beta-腎上腺素阻斷劑
- CInstruct the client to perform deep breathing exercises指導案主進行深呼吸運動
- DEncourage increased fluid intake to maintain blood volume鼓勵增加水分攝取以維持血容量
嗜鉻細胞瘤是腎上腺髓質腫瘤，會分泌大量兒茶酚胺（Catecholamines），導致極高血壓。處理高血壓危象時，藥物順序極其關鍵。必須先給予 Alpha-blocker（如 Phenoxybenzamine 或 Phentolamine）來放鬆血管擴張血壓。絕對不能在 Alpha-blocker 作用前先給 Beta-blocker（選項 B），因為阻斷 Beta-2 導致的血管擴張後，會讓 Alpha 受體獨自面對大量兒茶酚胺，造成不受拮抗的血管收縮，使血壓飆升得更高。這是 NCLEX 考題中關於安全性與生理機轉的進階考點。選項 C 效果有限，選項 D 可能因液體負荷增加而加重高血壓。
Pheochromocytoma is a tumor of the adrenal medulla that secretes large amounts of catecholamines, resulting in extremely high blood pressure. When managing a hypertensive crisis, the order of medication administration is critical. An alpha-blocker (such as phenoxybenzamine or phentolamine) must be given first to relax blood vessels and lower blood pressure. A beta-blocker (option B) must never be given before the alpha-blocker has taken effect, because blocking beta-2 mediated vasodilation leaves the alpha receptors to face massive catecholamines unopposed, producing unopposed vasoconstriction and an even greater rise in blood pressure. This is an advanced NCLEX concept involving safety and physiological mechanisms. Option C is of limited effectiveness, and option D may worsen hypertension through increased fluid load.
美國 NCLEX 非常強調藥物機轉的優先順序（Alpha before Beta），這被視為基礎安全準則；在台灣臨床，這類罕見疾病多由內分泌專科醫師下達精確醫囑，護理師較少需要自行判斷給藥順序，但仍需具備監測不良反應的能力。