護理師正在查閱一名因準備手術而禁食（NPO）病人的給藥紀錄（MAR）。護理師應針對哪種藥物向醫療提供者進行確認？
The nurse is reviewing the medication administration record (MAR) for a client who is NPO for a scheduled surgery. Which medication should the nurse clarify with the healthcare provider?
- AMetformin for type 2 diabetes✓ 正解用於第二型糖尿病的 Metformin
- BFamotidine for GERD用於胃食道逆流病的 Famotidine
- CMetoprolol for heart rate control用於控制心率的 Metoprolol
- DAmlodipine for hypertension用於高血壓的 Amlodipine
手術前 NPO 的藥物管理是減少手術風險的關鍵。一般原則是：抗高血壓藥物（如鈣離子通道阻斷劑 Amlodipine 或乙型阻斷劑 Metoprolol）通常會建議在術前早晨配小口水服用，以避免術中血壓飆升或心律不整。H2 阻斷劑（如 Famotidine）有時也會給予，以降低胃酸分泌，預防吸入性肺炎。然而，口服降血糖藥物（如 Metformin）在 NPO 狀態下必須停用，因為病人沒有進食，繼續服用會導致嚴重的低血糖（Hypoglycemia）風險。此外，Metformin 在使用含碘顯影劑的檢查中也有誘發乳酸中毒的風險。護理師必須確認醫師是否有開立術前的血糖監測與滑動比例胰島素（Sliding scale insulin）來替代口服藥。
Management of preoperative medications during NPO status is critical to reducing surgical risk. As a general rule, antihypertensive agents (such as the calcium channel blocker Amlodipine or the beta-blocker Metoprolol) are usually given on the morning of surgery with a small sip of water to prevent intraoperative blood pressure surges or arrhythmias. H2 blockers (such as Famotidine) may also be given to reduce gastric acid secretion and prevent aspiration pneumonia. However, oral hypoglycemic agents such as Metformin must be held during NPO status, because the client is not eating and continuing the medication carries a serious risk of hypoglycemia. In addition, Metformin can precipitate lactic acidosis when iodinated contrast is administered during imaging. The nurse must confirm whether the physician has ordered preoperative blood glucose monitoring and a sliding-scale insulin regimen to replace the oral medication.
美國醫院有非常明確的「Pre-op Medication Protocols」，護理師需根據指引判斷哪些藥該給、哪些該留。台灣臨床上，藥物是否服用多由麻醉科醫師在術前訪視時交代，護理師通常依據醫囑執行，較少主動針對個別口服藥提出質疑，但 NCLEX 考題要求護理師具備獨立判斷藥物風險的能力。