一位病人正透過中心靜脈導管接受全靜脈營養（TPN）。目前的 TPN 袋已空，但藥局尚未送達下一袋藥液。護理師應優先採取哪項行動？
A client is receiving total parenteral nutrition (TPN) via a central venous catheter. The TPN bag is empty, and the next bag is not yet available from the pharmacy. Which action should the nurse take first?
- AFlush the central line with normal saline and cap it以生理食鹽水沖洗中心靜脈導管並封管
- BCall the pharmacy to expedite the TPN delivery聯絡藥局加速 TPN 送達
- CSlow the current infusion to 10 mL/hr to keep the vein open將目前輸注速率減慢至 10 mL/hr 以維持血管通路
- DHang 10% dextrose in water (D10W) at the same rate✓ 正解以相同速率掛上 10% 葡萄糖水 (D10W)
TPN 含有極高濃度的葡萄糖。當 TPN 突然停止時，病人體內分泌的高濃度胰島素會導致「嚴重的反彈性低血糖」（Rebound Hypoglycemia）。為了防止這種潛在的致命危險，如果下一袋 TPN 無法及時銜接，護理師必須立即掛上含有 10% 葡萄糖的點滴（D10W），以維持血糖穩定。A 會導致低血糖。C 雖然想維持管路，但 10 mL/hr 的高糖液體不足以防止低血糖。B 雖然必要但不是「第一優先」的直接病人照護動作。護理優先級在於預防生理上的急劇惡化。
TPN contains an extremely high concentration of dextrose. When TPN is abruptly discontinued, the high circulating insulin levels in the client can precipitate severe rebound hypoglycemia. To prevent this potentially fatal complication, if the next TPN bag is not available in time, the nurse must immediately hang 10% dextrose in water (D10W) to maintain blood glucose stability. Option A would cause hypoglycemia. Although option C attempts to keep the line patent, the hypertonic glucose solution running at 10 mL/hr is insufficient to prevent hypoglycemia. Option B, while necessary, is not the first-priority direct patient care action. Nursing priority focuses on preventing acute physiological deterioration.
美國 NCLEX 規定 TPN 銜接不上必掛 D10W；台灣臨床上則有時會掛 D5W 或視病人血糖狀況決定，但考試必須選 D10W（或 D20W），因為 TPN 濃度通常很高，需較高糖分維持。