— 心理社會完整性 · HARD · MCQ —
一位服用鋰鹽（Lithium carbonate）三週的個案，下列哪個評估發現需要立即通知醫師？
A nurse is evaluating a client who has been taking lithium carbonate for 3 weeks. Which assessment finding requires immediate notification of the provider?
- AWeight gain of 2 pounds體重增加2磅
- BFine hand tremors at rest靜止時的細微手部震顫
- CCoarse tremors, confusion, and ataxia✓ 正解粗大震顫、意識混亂和步態不穩
- DMild polyuria and thirst輕度多尿和口渴
— Explanation · 中文詳解 —
鋰鹽治療指數窄，需密切監測毒性。粗大震顫、意識混亂、運動失調是鋰鹽中毒的典型徵象（C）。細微震顫（B）、多尿（D）與輕微體重增加（A）屬於常見的副作用，通常在調整劑量後可緩解，但中毒症狀危及生命，需立即處理。
Lithium has a narrow therapeutic index and requires close monitoring for toxicity. Coarse tremors, confusion, and ataxia are classic signs of lithium toxicity (C). Fine tremors (B), polyuria (D), and minor weight gain (A) are common expected side effects that can usually be managed by dose adjustment, but the signs of toxicity are life-threatening and require immediate intervention.
✦ 台美臨床差異
美台皆須嚴密監測鋰鹽濃度，台灣藥師參與藥物衛教比例提升，但護理師仍是臨床監測中毒徵象的第一線人員。