護理師正在指導病人關於 lisinopril（ACE 抑制劑）的副作用。護理師應指導病人立即回報哪些症狀？（選所有適合的）
A nurse is teaching a client about the adverse effects of lisinopril. Which symptoms should the nurse instruct the client to report immediately? (Select all that apply.)
- ASwelling of the tongue or lips✓ 正解舌頭或嘴唇腫脹
- BPersistent dry cough持續性乾咳
- CDizziness when standing up站起時的頭暈
- DFacial puffiness✓ 正解臉部浮腫
- EYellowing of the skin皮膚變黃
Lisinopril 屬於 ACE 抑制劑（ACEI），其最嚴重且具致命性的副作用是血管神經性水腫（Angioedema）。這表現為舌頭、嘴唇、臉部甚至喉嚨的腫脹，可能導致氣道阻塞。因此，選項 A 和 D 是必須立即回報且需急診處理的紅旗徵象。至於選項 B（慢性乾咳），雖然是 ACEI 常見的副作用（因緩激肽積聚），但通常不具生命威脅，僅需評估是否換藥，不需『立即』回報（除非影響生活）。選項 C（姿勢性低血壓）是降壓藥的預期效應，應教導緩慢起身。選項 E（黃疸）與 ACEI 關聯較小，更多見於肝毒性藥物。本題重點在於區分『不適感』與『致命風險』。
Lisinopril is an ACE inhibitor (ACEI), and its most severe and potentially fatal adverse effect is angioedema. This presents as swelling of the tongue, lips, face, and possibly the throat, and may cause airway obstruction. Therefore, options A and D are red-flag symptoms that must be reported immediately and require emergency management. Option B (chronic dry cough), although a common side effect of ACEIs (due to bradykinin accumulation), is generally not life-threatening; it warrants assessment for possible medication change but does not require 'immediate' reporting unless it affects quality of life. Option C (orthostatic hypotension) is an expected effect of antihypertensive therapy, and the client should be taught to rise slowly. Option E (jaundice) is rarely associated with ACEIs and is more often seen with hepatotoxic drugs. The key to this question is distinguishing 'discomfort' from 'life-threatening risk.'
在美國，Angioedema 在非裔美國人中發生率較高，衛教時會特別強調此族群風險；台灣臨床則常見病人因 ACEI 引起的乾咳而自行停藥，護理師需加強解釋此為常見藥理反應而非感冒。