病人正在接受靜脈輸注氯化鉀，下列哪項評估發現需要護理師立即停止輸注？
A client is receiving an intravenous infusion of potassium chloride. Which assessment finding requires the nurse to immediately stop the infusion?
- AClient reports burning at the IV site✓ 正解病人報告靜脈注射部位有灼熱感
- BUrine output of 40 mL per hour每小時尿量 40 mL
- CSerum potassium level of 4.8 mEq/L血清鉀濃度 4.8 mEq/L
- DHeart rate change from 82 bpm to 88 bpm心率從 82 bpm 變更為 88 bpm
氯化鉀具有強烈的組織刺激性，輸注部位產生燒灼感通常暗示藥物外滲或靜脈炎，必須立即停止輸注以預防嚴重組織壞死。D選項心率變化在正常範圍內，C選項血鉀濃度處於正常範圍，B選項尿量充足，皆不需停藥。此評估著重於給藥安全性與防範化學性傷害。
Potassium chloride is highly irritating to tissues, and burning at the infusion site usually indicates extravasation or phlebitis. The infusion must be stopped immediately to prevent severe tissue necrosis. Option D reflects a heart rate change within normal limits, option C shows a normal serum potassium level, and option B indicates adequate urine output, none of which require discontinuation. This assessment focuses on medication safety and prevention of chemical injury.
美國醫院多嚴格規定鉀離子需經由中央靜脈或設定最大輸注速率；台灣在周邊靜脈輸注時，護理師需極度警惕外滲徵兆。