— 藥理與非經腸給藥 · HARD · SATA —
一位使用萬古黴素（Vancomycin）的病人出現以下何種狀況應立即回報醫師？（選所有適合的）
A nurse is providing care to a client receiving Vancomycin. Which findings should the nurse report to the healthcare provider immediately? (Select all that apply.)
- AFlushing of the face and neck臉部和頸部潮紅
- BDecreased urine output✓ 正解尿量減少
- CWheezing and dyspnea✓ 正解喘鳴和呼吸困難
- DIncreased peak serum concentration✓ 正解血清峰值濃度增加
- EHypotension✓ 正解低血壓
— Explanation · 中文詳解 —
萬古黴素具腎毒性與耳毒性，尿量減少代表腎功能受損；喘鳴、呼吸困難與低血壓提示過敏反應或輸注過快引起的全身反應。尖峰濃度升高則有毒性風險。面頸潮紅（Red man syndrome）雖需處理但可透過減慢速度緩解，非立即停藥指標。
Decreased urine output, wheezing, dyspnea, increased peak serum vancomycin levels, and hypotension are serious adverse effects indicating nephrotoxicity, anaphylaxis, or systemic toxicity. While flushing may indicate Red Man Syndrome, it is typically managed by slowing the infusion, whereas the other findings require immediate provider notification for potential discontinuation or emergency treatment.
✦ 台美臨床差異
美國護理師常參與藥物濃度監測流程（TDM），台灣臨床多由藥劑部主動通知調整劑量。