一位病人因高血壓被處方服用螺內酯（Spironolactone）。護理師應最密切監測哪項實驗室檢查結果？

Spironolactone 是一種「保鉀利尿劑（Potassium-sparing diuretic）」，其作用機制是在遠端腎小管拮抗醛固酮（Aldosterone），進而排鈉排尿但保留鉀離子。與常見的 Furosemide（會造成低血鉀）不同，Spironolactone 最主要的副作用是高血鉀（Hyperkalemia）。高血鉀會導致心律不整甚至心跳停止，因此護理師必須最優先關注血鉀水平（D）。對於腎功能不全或同時服用 ACEI/ARB 的病人，風險更高。護理衛教應包含：避免攝取高鉀食物（如香蕉、柑橘）及市售代鹽（通常含鉀）。掌握各類利尿劑對電解質的不同影響是藥物護理的基礎。

Spironolactone is a potassium-sparing diuretic that acts by antagonizing aldosterone in the distal renal tubule, promoting sodium and water excretion while retaining potassium. Unlike furosemide (which causes hypokalemia), the major adverse effect of spironolactone is hyperkalemia. Hyperkalemia can cause dysrhythmias and even cardiac arrest, so the nurse must monitor the serum potassium level most closely (D). The risk is even greater in clients with renal insufficiency or those concurrently taking an ACE inhibitor or ARB. Patient education should include avoidance of foods high in potassium (such as bananas and oranges) and commercial salt substitutes (which often contain potassium). Understanding the different electrolyte effects of various diuretics is fundamental to medication nursing.

美國 NCLEX 考試非常愛考保鉀與排鉀利尿劑的對比；在台灣，許多高血壓病人常服用複合劑型，護理師需確認病人是否知道自己服用的具體成份，以免誤食含鉀代鹽造成意外。