護理師正給予萬古黴素（vancomycin）的靜脈輸注。在開始輸注前，哪項是首要的護理評估？
A nurse is administering an IV infusion of vancomycin. Which is a priority nursing assessment before starting the infusion?
- AClient's bowel sounds個案的腸蠕動音
- BClient's allergy history✓ 正解個案的過敏史
- CClient's recent urine output個案近期的尿液排出量
- DClient's current temperature個案目前的體溫
萬古黴素（vancomycin）是治療抗甲氧西林金黃色葡萄球菌（MRSA）等革蘭氏陽性菌感染的關鍵抗生素。 選項 B 正確：給予任何抗生素前，評估過敏史（drug allergies）是首要的安全步驟。Vancomycin 可能引起：① 真性過敏（anaphylaxis）—需立即停藥並急救。② 紅人症候群（red man syndrome）—因輸注過快導致組織胺釋放，雖非真過敏但需減慢輸注速度。確認過敏史能預防致命反應。 選項 D 錯誤：體溫雖是用藥前一般評估項目，但對啟動 vancomycin 而言，過敏史優先級更高。 選項 C 錯誤：尿量反映腎功能，與 vancomycin 腎毒性監測有關，但屬於用藥期間追蹤，非啟動前首要評估。 選項 A 錯誤：腸蠕動音與 IV vancomycin 給藥無直接關聯。
Vancomycin is a key antibiotic for gram-positive infections including MRSA. B is correct: Assessing drug allergies before any antibiotic is the priority safety step. Vancomycin can cause: (1) true anaphylaxis—requires immediate stop and emergency response; (2) red man syndrome—a histamine release from rapid infusion (not true allergy but managed by slowing infusion). Allergy assessment prevents life-threatening reactions. D is incorrect: Temperature is routine but secondary to allergy assessment for vancomycin initiation. C is incorrect: Urine output is relevant for monitoring nephrotoxicity during therapy, not the priority pre-infusion check. A is incorrect: Bowel sounds are unrelated to IV vancomycin.
美國的醫院評鑑標準（如 JCAHO）嚴格要求給藥前的過敏史確認；台灣的醫療機構也將此列為標準作業程序。