一位病人出現疑似鋰鹽中毒的徵象，護理師應優先評估哪項發現？
A client presents with signs of potential lithium toxicity. Which assessment finding should the nurse prioritize?
- AMild nausea輕微噁心
- BIncreased thirst口渴增加
- CFine hand tremors手部細微震顫
- DCoarse tremors and ataxia✓ 正解粗大震顫和共濟失調
鋰鹽（Lithium）的治療指數極窄，中毒徵象從輕微到嚴重不等。粗大震顫與共濟失調（Ataxia）為神經毒性惡化的重要指標，顯示血中濃度可能已超過 2.0 mEq/L，屬於嚴重中毒範疇。護理師需優先評估神經學狀態以判斷是否需立即停藥、通知醫師並準備血液檢查。相較於輕微的震顫或腸胃症狀，神經系統的功能受損對病人的安全性威脅最高。
Lithium has a narrow therapeutic index, and toxicity spans mild to severe. Coarse tremors and ataxia indicate worsening neurotoxicity, suggesting serum levels may exceed 2.0 mEq/L—a serious toxicity range. The nurse must prioritize neurologic assessment to determine whether to hold the drug, notify the provider, and obtain labs. Compared with mild tremor or GI symptoms, neurologic dysfunction poses the greatest safety threat.
在美國臨床實務中，對於鋰鹽中毒的評估極為重視「神經學基準線（Baseline）」。護理師需在給藥前確認病人有無步態不穩或構音障礙，若發現異常會立即扣住藥物（Hold medication）並聯繫醫師，此流程在美國醫療體系中因法律責任與病人安全規範極為嚴格。