— 藥理與非經腸給藥 · MEDIUM · MCQ —
病人獲醫囑開立靜脈注射萬古黴素，若給藥期間觀察到下列何種狀況，護理師應立即介入？
A client is prescribed intravenous vancomycin. The nurse should intervene if which action is noted during administration?
- AFlushing of the face, neck, and upper torso臉部、頸部和上軀乾潮紅
- BThe client is sitting upright in bed客戶坐直在床上
- CThe client reports mild itching at the infusion site客戶報告輸注部位有輕微搔癢
- DThe infusion is set to run over 60 minutes✓ 正解輸注設定為在 60 分鐘內完成
— Explanation · 中文詳解 —
萬古黴素若輸注速度過快會引發紅人症候群（Red Man Syndrome），表現為臉部與上半身潮紅，建議輸注時間至少 60-90 分鐘。選項 D 明確顯示給藥時間過短，這是導致嚴重併發症的主要風險，必須立即減慢速度。
If vancomycin is infused too rapidly, it can precipitate Red Man Syndrome, presenting as flushing of the face and upper body. The recommended infusion time is at least 60-90 minutes. Option D clearly indicates that the infusion duration is too short, which is the primary risk factor for a serious complication, and the rate must be slowed immediately.
✦ 台美臨床差異
台灣醫院通常針對萬古黴素有嚴格的滴速給藥規範，護理師依醫囑設定，但臨床上常因過度忙碌未準確控制時間，增加此類風險。