經驗豐富的 RN 正在監督新進 RN。新進 RN 準備了一劑高濃度的靜脈氯化鉀 (KCl)，並將其直接接上病患的周邊靜脈留置針，準備『直接快速靜脈推注 (IV push)』。監督的 RN 最恰當的行動為何？
An experienced registered nurse (RN) is supervising a newly licensed RN on a busy acute care unit. The new RN prepares a heavy dose of concentrated intravenous potassium chloride (KCl) and attaches it directly to the client's simple peripheral IV port to inject it rapidly via IV push. What is the most appropriate action by the supervising RN?
- AIntervene instantly and violently halt the administration, as IV push potassium causes immediate lethal cardiac arrest.✓ 正解立即介入並強力制止給藥，因為靜脈推注鉀離子會導致立即致命的心臟停搏。
- BTell the newly licensed RN to dilute the potassium slightly before finishing the IV push.告知新進護理師在完成靜脈推注前先將鉀離子稍微稀釋。
- CPraise the newly licensed RN for strictly upholding rigorous prompt electrolyte replacement protocols efficiently.讚美新進護理師有效率地嚴格遵守嚴格的電解質快速補充協議。
- DState that potassium injections dictate placing a cold pack over the IV site to prevent local burning.說明鉀離子注射規定在靜脈注射部位上方放置冰包以防止局部灼傷。
本題測驗高警訊用藥的絕對禁忌。靜脈氯化鉀 (IV KCl) 絕對不可以用『直接靜脈推注 (IV push)』的方式給藥。一次性快速推注高濃度的鉀進入血管，會瞬間引發心臟去極化而鎖死，造成致命的『心室纖維顫動及心跳停止 (cardiac arrest)』。KCl 必須加入大容量點滴中以幫浦極緩慢地滴注 (通常不超過 10 mEq/hr)。護理師若看到有人推注鉀離子，唯一正確的行動就是立即制止給藥。
The nurse must immediately intervene and stop the administration because intravenous push of concentrated potassium chloride can cause immediate, fatal cardiac arrest. Potassium chloride is a high-alert medication that must always be diluted and administered slowly via infusion pump, never as a direct bolus.
IV Push KCl (推注鉀離子) = 謀殺死刑。這是護理系國考最基礎且最重要的安全鐵律。