— 藥理與非經腸給藥 · HARD · SATA —
病人接受靜脈注射萬古黴素時，護理師應優先監測哪些徵象？（選所有適合的）
Which of the following signs should the nurse prioritize when monitoring a client receiving vancomycin IV? (Select all that apply.)
- AFlushing of the face and neck✓ 正解臉部和頸部潮紅
- BDecreased urine output✓ 正解尿液輸出量減少
- CHypotension✓ 正解低血壓
- DWheezing✓ 正解喘鳴
- EElevated white blood cell count白血球計數升高
— Explanation · 中文詳解 —
萬古黴素使用時常見紅人症候群（Red Man Syndrome），表現為臉頸部潮紅。此外，萬古黴素具腎毒性與耳毒性，故須監測尿量（腎功能）。過敏反應如低血壓或氣喘亦需緊急處理。WBC 升高為治療目標而非副作用。
Nurses must monitor for Red Man syndrome, indicated by flushing of the face and neck, which results from rapid infusion and histamine release. Additionally, vigilance for nephrotoxicity (decreased urine output) and severe hypersensitivity reactions, such as hypotension and wheezing, is critical due to vancomycin's potential adverse effects.
✦ 台美臨床差異
美台臨床皆重視萬古黴素血中濃度（Trough level）監測，台灣更嚴格要求執行劑量調整計算。