— 生理適應 · EASY · MCQ —
一位第一型糖尿病病人被發現意識不清、盜汗且心跳過速。護理師應優先採取什麼行動？
A client with type 1 diabetes mellitus is found unconscious, diaphoretic, and tachycardic. Which action should the nurse prioritize?
- ACheck capillary blood glucose✓ 正解測量毛細血管血糖
- BAdminister intramuscular glucagon注射肌肉型升糖素
- CAdminister 50% dextrose IV push靜脈推注50%葡萄糖
- DAssess the client's airway評估病人呼吸道
— Explanation · 中文詳解 —
低血糖休克（Hypoglycemic shock）是糖尿病病人常見的急性併發症。當病人出現意識不清、盜汗、心跳過速等交感神經激發徵兆時，必須遵循 ABC（Airway, Breathing, Circulation）原則，但首要任務是「確認診斷」。在給予任何處置前，必須先透過血糖檢測確認是否為低血糖，以避免對高血糖病人錯誤給糖。
Hypoglycemic shock is a common emergency in type 1 diabetes. With altered mental status, diaphoresis, and tachycardia, the nurse must follow assessment-first principles: confirm the diagnosis by checking capillary blood glucose before administering glucose, dextrose, or glucagon, to avoid worsening a hyperglycemic crisis.