— 藥理與非經腸給藥 · MEDIUM · SATA —
病人服用華法林（Warfarin）治療。護理師應辨識出哪些徵象為潛在不良反應？（選所有適合的）
A client is prescribed warfarin therapy. Which findings should the nurse identify as indicators of potential adverse effects? (Select all that apply.)
- AGingival bleeding while brushing teeth✓ 正解刷牙時牙齦出血
- BPresence of petechiae on the skin✓ 正解皮膚出現瘀點
- CAbdominal pain with black, tarry stools✓ 正解腹痛伴隨黑色焦油樣糞便
- DIncreased international normalized ratio (INR)國際標準化比率（INR）升高
- EFrequent nosebleeds✓ 正解頻繁流鼻血
— Explanation · 中文詳解 —
華法林為抗凝血劑，主要副作用為出血傾向。牙齦流血、瘀點、黑便（上消化道出血）及反覆鼻出血皆是藥物過量或療效過強導致出血的指標。D 選項 INR 升高是預期的藥效反應，除非數值過高導致臨床出血，否則本身不被歸類為「不良副作用」。
Warfarin is an anticoagulant whose principal adverse effect is bleeding. Gingival bleeding, petechiae, black tarry stools (upper GI bleeding), and recurrent epistaxis are all indicators of over-anticoagulation or excessive drug effect. Option D, an elevated INR, is an expected pharmacologic response; unless the value is high enough to cause clinical bleeding, it is not itself classified as an adverse effect.
✦ 台美臨床差異
台灣針對使用 Warfarin 的病人衛教強度極高，常使用抗凝血衛教卡進行監測。