一位病人預計在 2 小時後進行心導管檢查。下列哪項檢驗結果護理師應「立即」向醫師回報？
A client is scheduled for a cardiac catheterization in 2 hours. Which laboratory result should the nurse report to the healthcare provider immediately?
- APotassium 3.8 mEq/L鉀離子 3.8 mEq/L
- BWhite blood cell count 9,500/mm3白血球計數 9,500/mm3
- CCreatinine 2.4 mg/dL✓ 正解肌酸酐 2.4 mg/dL
- DHemoglobin 12.5 g/dL血紅素 12.5 g/dL
心導管檢查涉及使用放射性對比劑（Contrast media），對比劑主要經由腎臟代謝，具有潛在的神經毒性和腎毒性。血清肌酸酐（Creatinine）水平升高（2.4 mg/dL 顯著高於正常值 0.6-1.2 mg/dL）代表病人存在腎功能不全，這會極大地增加「對比劑誘發之急性腎損傷」（Contrast-induced nephropathy, CIN）的風險。在檢查前，護理師必須識別此風險並回報，醫師可能會決定延後檢查、更改對比劑劑量或給予大量生理食鹽水預注以保護腎臟。其他選項（A、D、B）均在正常或接近正常範圍內，不構成立即取消或更改手術計畫的理由。
Cardiac catheterization uses iodinated contrast media that is excreted by the kidneys and is potentially neurotoxic and nephrotoxic. Elevated serum creatinine (2.4 mg/dL, well above normal 0.6-1.2 mg/dL) indicates renal insufficiency, greatly increasing the risk of contrast-induced nephropathy (CIN). Before the procedure, the nurse must identify this risk and report it; the physician may decide to postpone the procedure, modify contrast dose, or pre-hydrate with saline. The other options (A, D, B) are within or near normal range and do not warrant immediate cancellation or modification.
美國 NCLEX 考題非常強調護理師在門診或手術前預檢（Pre-procedure check）的主動權；台灣護理師通常在接到檢驗報告時就會刷進電腦系統，若有紅字通常醫師也會看到，但護理師仍負有口頭提醒的法律責任。