— 降低風險 · HARD · MCQ —
護理師準備為低血鉀病人靜脈輸注氯化鉀。給藥前最重要的評估為何？
A nurse is preparing to administer potassium chloride IV to a client with hypokalemia. Which assessment is priority before starting the infusion?
- AVerify the presence of adequate urine output✓ 正解確認有足夠的尿量
- BCheck the client's morning fasting glucose檢查個案早晨空腹血糖
- CEvaluate the client's peripheral pulse strength評估個案周邊脈搏強度
- DAssess the client's current blood pressure測量個案目前血壓
— Explanation · 中文詳解 —
氯化鉀具有高腎毒性與心律不整風險。若病人無尿或少尿（少於 0.5 mL/kg/hr），輸注鉀離子極易導致嚴重高血鉀，引發致命性心律不整。給予鉀離子前，確保腎臟功能正常且尿液輸出量足夠是臨床安全給藥的鐵律，以避免藥物蓄積。
Potassium chloride is highly nephrotoxic and arrhythmogenic. In a patient with anuria or oliguria (less than 0.5 mL/kg/hr), infusion of potassium can readily cause severe hyperkalemia and life-threatening arrhythmias. Ensuring normal renal function and adequate urine output before administering potassium is an inviolable rule for safe clinical administration to prevent drug accumulation.
✦ 台美臨床差異
台美皆嚴格執行給藥前評估。美國護理師常需在電氣記錄系統中勾選尿量檢查項目，台灣則較依賴護理紀錄與醫囑查核。