一名 55 歲高血壓病史患者被開立 lisinopril。護理師在初次評估時應優先評估下列哪項發現？
A 55-year-old client with a history of hypertension is prescribed lisinopril. Which assessment finding should the nurse prioritize during the initial evaluation?
- ASerum potassium level of 3.8 mEq/L血清鉀濃度為 3.8 mEq/L
- BPresence of mild peripheral edema in lower extremities下肢有輕度周邊水腫
- CPresence of a persistent dry, non-productive cough✓ 正解有持續性的乾咳且無痰
- DBlood pressure reading of 138/88 mmHg血壓讀數為 138/88 mmHg
ACE 抑制劑（如 lisinopril）最常見的副作用是持續性乾咳，這是因為藥物阻斷了緩激肽（bradykinin）的分解，導致其在肺部堆積刺激呼吸道。這雖然不是致命併發症，但卻是造成病人服藥順從性低落的主因，護理師需在衛教時告知並觀察。若發生乾咳，醫師通常會改開 ARBs（如 losartan）來替代。其他選項中，鉀離子 3.8 是正常範圍，BP 138/88 雖然還未達極理想，但已比服用前改善，且水腫通常與藥物無直接相關。此題重點在於藥物副作用教育與病人依從性的維持，避免病人因不適而自行停藥。
The most common adverse effect of ACE inhibitors such as lisinopril is a persistent dry cough, caused by inhibition of bradykinin degradation, leading to its accumulation in the lungs and irritation of the airways. Although not life-threatening, this side effect is a major cause of poor medication adherence; the nurse should educate the client and monitor for its occurrence. If a dry cough develops, the physician will usually switch to an ARB such as losartan. Among the other options, a potassium level of 3.8 is within normal range, a BP of 138/88, while not yet ideal, has improved from baseline, and edema is not directly related to the medication. The focus of this question is patient education about side effects and maintaining adherence, preventing the client from discontinuing the drug due to discomfort.
美國護理師對 ACEI 引發的乾咳衛教極為重視，因為直接影響慢性病管理績效；台灣臨床則常因為病人主訴咳嗽而被視為感冒，反而忽略藥物史的釐清，護理師需更主動回報此類副作用。