一位服用 thiazide 類利尿劑的病人，血清鉀為 3.4 mEq/L。病人沒有症狀，心電監視器顯示正常竇性心律。護理師最適當的行動是哪一項？
A client who takes a thiazide diuretic has a serum potassium level of 3.4 mEq/L. The client is asymptomatic, and the cardiac monitor shows normal sinus rhythm. Which action by the nurse is most appropriate?
- ANotify the provider of the result and encourage potassium-rich foods such as bananas, citrus fruits, and potatoes通知醫療提供者這項檢驗結果，並鼓勵攝取香蕉、柑橘類水果與馬鈴薯等富含鉀的食物正確答案
- BPrepare to administer potassium chloride by intravenous push to correct the level quickly準備以靜脈推注（IV push）方式給予氯化鉀，快速矯正血鉀
- CInstruct the client to restrict dietary sodium so that the potassium level will rise指導病人限制飲食中的鈉攝取，藉此提高血鉀濃度
- DInfuse 40 mEq of potassium chloride over 30 minutes through a peripheral intravenous line以周邊靜脈導管在 30 分鐘內輸注 40 mEq 氯化鉀
- A通知醫療提供者這項檢驗結果，並鼓勵攝取香蕉、柑橘類水果與馬鈴薯等富含鉀的食物
正確答案是 A。血清鉀低於 3.5 mEq/L 即為低血鉀，3.0 至 3.4 mEq/L 屬輕度。本例病人沒有症狀、心電監視器顯示正常竇性心律，處置以飲食或口服補鉀為主，並通知醫療提供者評估是否調整 thiazide 類利尿劑或加開口服氯化鉀。富含鉀的食物包括香蕉、柑橘類水果、馬鈴薯、番茄、菠菜與豆類。B：氯化鉀絕對不可靜脈推注，快速推注會使血鉀驟升而造成致命的心律不整。C：限制鈉攝取無法補充鉀，與矯正低血鉀無關。D：靜脈補鉀只用於中重度低血鉀（低於 3.0 mEq/L）、有症狀、心電圖出現變化或無法口服者；周邊靜脈輸注速率一般不超過每小時 10 mEq，在 30 分鐘內給 40 mEq 遠超上限，需中央靜脈導管與連續心電監測。護理師仍應持續監測肌肉無力、痙攣、便秘與心律不整，注意心電圖上 T 波平坦與 U 波，並留意同時使用 digoxin 的病人毒性風險上升。來源：Lewis, Medical-Surgical Nursing（Fluid, Electrolyte, and Acid-Base Imbalances）；Institute for Safe Medication Practices（ISMP）靜脈氯化鉀安全建議。
- A · 正確答案通知醫療提供者這項檢驗結果，並鼓勵攝取香蕉、柑橘類水果與馬鈴薯等富含鉀的食物
正確。輕度且無症狀的低血鉀以飲食或口服補鉀為主，同時通知醫療提供者評估是否調整利尿劑；香蕉、柑橘類與馬鈴薯都是含鉀量高的食物。
- B準備以靜脈推注（IV push）方式給予氯化鉀，快速矯正血鉀
錯誤。氯化鉀絕對不可靜脈推注，快速推注會使血鉀驟升而造成致命心律不整，這是高警訊藥物的絕對禁忌。
- C指導病人限制飲食中的鈉攝取，藉此提高血鉀濃度
錯誤。限制鈉攝取不會提高血鉀濃度，與矯正低血鉀無關，反而可能延誤真正需要的補鉀措施。
- D以周邊靜脈導管在 30 分鐘內輸注 40 mEq 氯化鉀
錯誤。周邊靜脈補鉀速率一般不超過每小時 10 mEq，30 分鐘給 40 mEq 遠超上限；輕度無症狀低血鉀也不需要靜脈途徑。
美國多數醫院把氯化鉀列為高警訊藥物，一般病房不存放濃縮氯化鉀，改用藥局預混袋並以輸液幫浦給藥；台灣同樣納入高警訊藥品管理，但部分單位仍由護理師依醫囑在病房稀釋，因此雙人核對與速率上限更需落實。
English explanation
Option A is correct. A serum potassium below 3.5 mEq/L defines hypokalemia, and a level of 3.0 to 3.4 mEq/L is mild. Because this client is asymptomatic and the monitor shows normal sinus rhythm, management centers on dietary or oral replacement, and the provider is notified to decide whether the thiazide diuretic should be adjusted or an oral potassium supplement added. Potassium-rich foods include bananas, citrus fruits, potatoes, tomatoes, spinach, and legumes. Option B is incorrect because potassium chloride must never be given by intravenous push; a rapid bolus can cause a fatal dysrhythmia. Option C is incorrect because restricting sodium does not replace potassium and does not correct hypokalemia. Option D is incorrect because intravenous replacement is reserved for moderate to severe hypokalemia, symptoms, electrocardiographic changes, or inability to take oral potassium; the usual peripheral rate does not exceed 10 mEq per hour, so 40 mEq over 30 minutes far exceeds that limit and would require a central line with continuous cardiac monitoring. The nurse continues to monitor for muscle weakness, cramping, constipation, and dysrhythmias and watches for flattened T waves and U waves, especially in clients who also take digoxin. Source: Lewis, Medical-Surgical Nursing (fluid, electrolyte, and acid-base imbalances); Institute for Safe Medication Practices (ISMP) recommendations on intravenous potassium chloride.