一位慢性腎臟病病人主訴肌肉無力與心悸，心電圖顯示 T 波高尖。護理師應優先執行何項措施？
A client with chronic kidney disease (CKD) reports muscle weakness and palpitations. The EKG shows peaked T waves. Which intervention is the priority?
- AAdminister regular insulin with dextrose給予常規胰島素與葡萄糖
- BObtain a serum potassium level測量血清鉀濃度
- CAdminister sodium polystyrene sulfonate給予聚苯乙烯磺酸鈉
- DAdminister intravenous calcium gluconate✓ 正解靜脈注射葡萄糖酸鈣
高血鉀症（Hyperkalemia）引發的心電圖變化（如 T 波高尖）代表心肌已發生電生理異常，有引發致死性心律不整（如心室顫動）的風險。此時優先順序為：先穩定心肌細胞膜，再進行降鉀治療。靜脈注射葡萄糖酸鈣（Calcium Gluconate）雖無法降低血鉀濃度，但能迅速拮抗鉀離子對心肌膜電位的影響，是搶救生命的第一步。
Peaked T waves indicate hyperkalemia, which poses an immediate risk for lethal arrhythmias such as ventricular fibrillation. The priority intervention is to administer intravenous calcium gluconate to stabilize the cardiac cell membrane and protect against these dangerous rhythm disturbances. Other treatments like insulin or kayexalate work more slowly and do not provide immediate cardiac protection.
美國臨床對於高血鉀的緊急處置（Calcium -> Insulin/Dextrose -> Kayexalate/Dialysis）有明確的 priority 邏輯，考試中需嚴格遵循「先穩定心肌、後降低濃度」的原則。