— 藥理與非經腸給藥 · MEDIUM · SATA —
病人獲醫囑開立肝素（Heparin）靜脈輸注。下列哪些發現屬於藥物不良反應，護理師應立即回報醫師？（選所有適合的）
A client is prescribed intravenous heparin. Which of the following findings should the nurse identify as an adverse effect and report to the healthcare provider? (Select all that apply.)
- AGum bleeding during tooth brushing✓ 正解刷牙時牙齦出血
- BBlack, tarry stools✓ 正解黑色柏油樣糞便
- CBruising at the injection site注射部位瘀青
- DHematuria✓ 正解血尿
- EEpistaxis✓ 正解鼻出血
— Explanation · 中文詳解 —
肝素為抗凝血劑，常見副作用為出血。選項中除注射部位輕微瘀青（正常現象）外，牙齦出血、柏油便、血尿、流鼻血均代表凝血功能過度抑制，可能導致嚴重內出血，必須立即通知醫師重新調整劑量或檢測凝血指標（aPTT）。
Gum bleeding, black tarry stools, hematuria, and epistaxis are signs of excessive anticoagulation and potential serious bleeding that require immediate provider notification. Minor bruising at the injection site is an expected finding and does not typically indicate a complication requiring intervention.
✦ 台美臨床差異
台美皆強調觀察出血徵象，但美國護理師在監測與決定是否持藥的自主性較高。