— 藥理與非經腸給藥 · HARD · MCQ —
一位第二型糖尿病病人被開立二甲雙胍（Metformin）。護理師觀察到哪項評估結果需要立即跟進？
A client with type 2 diabetes mellitus is prescribed metformin. Which assessment finding requires immediate follow-up by the nurse?
- AReports of mild diarrhea報告有輕微腹瀉
- BSerum creatinine level of 2.2 mg/dL✓ 正解血清肌酸酐濃度為 2.2 mg/dL
- CFasting blood glucose of 140 mg/dL空腹血糖為 140 mg/dL
- DWeight loss of 2 lbs in one month一個月內體重減輕 2 磅
— Explanation · 中文詳解 —
二甲雙胍主要經由腎臟排泄。當腎功能受損（如肌酸酐上升至 2.2 mg/dL）時，病人在服用此藥後發生乳酸中毒的風險極高。臨床上必須監測腎功能指數，避免因藥物蓄積引發致命性代謝性酸中毒，故此數值顯示腎功能衰竭需高度警戒。
Metformin is excreted by the kidneys, and renal impairment significantly increases the risk of lactic acidosis, a potentially fatal complication. A serum creatinine level of 2.2 mg/dL indicates compromised kidney function, requiring immediate follow-up to prevent drug accumulation and metabolic acidosis.
✦ 台美臨床差異
在台灣，針對腎功能指標的藥物調整較多由醫師決定，護理師需在給藥前確認報告並主動回報。