— 藥理與非經腸給藥 · HARD · MCQ —
護理師監測使用硫酸鎂治療子癇前症的病人，下列哪項發現優先級最高？
A nurse is assessing a client receiving IV magnesium sulfate for pre-eclampsia. Which finding is the highest priority?
- AAbsent patellar reflexes✓ 正解膝反射消失
- BSerum magnesium level of 6 mg/dL血清鎂濃度 6 mg/dL
- CReports of flushing and warmth主訴潮紅和溫暖感
- DRespiratory rate of 14 breaths/min呼吸頻率 14 次/分
— Explanation · 中文詳解 —
硫酸鎂中毒跡象依序為：深部肌腱反射消失、呼吸變慢、心臟停搏。膝反射消失是早期神經肌肉毒性指標，必須立即停藥並採取解毒措施（葡萄糖酸鈣）。呼吸 14 次與濃度 6 mg/dL 均處於治療邊緣或正常範圍內，優先級低於反射消失。
Signs of magnesium toxicity progress in sequence: loss of deep tendon reflexes, decreased respirations, then cardiac arrest. Absent patellar reflexes are an early neuromuscular toxicity indicator and require immediate cessation and antidote (calcium gluconate). A respiratory rate of 14/min and a level of 6 mg/dL are at the edge of therapeutic or within normal range and are lower priority than absent reflexes.
✦ 台美臨床差異
台灣與美國對於產科硫酸鎂管理極為相似，皆強調深部肌腱反射與呼吸次數監測。