— 藥理與非經腸給藥 · HARD · MCQ —
護理師為病人靜脈注射萬古黴素，病人突發面部潮紅、瘙癢及低血壓，優先處置為何？
A nurse is administering IV vancomycin to a client. The client suddenly develops flushing, pruritus, and hypotension. What is the nurse's priority action?
- AStop the medication infusion✓ 正解停止藥物輸注
- BObtain a set of vital signs測量一組生命徵象
- CSlow down the infusion rate減慢輸注速率
- DAdminister an antihistamine給予抗組織胺
— Explanation · 中文詳解 —
此反應為萬古黴素輸注症候群（Red Man Syndrome），由輸注速度過快導致組織胺釋放引起。處理原則應先停止輸注，再評估生命徵象並通知醫師，視情況給予抗組織胺。直接減速無法緩解既發的嚴重低血壓症狀，必須先中斷給藥。
The symptoms describe Red Man Syndrome, caused by rapid infusion leading to histamine release. The priority action is to stop the infusion immediately to prevent further reaction, followed by assessing vital signs and administering antihistamines as ordered.
✦ 台美臨床差異
美台臨床對於萬古黴素輸注速率均極為謹慎，台灣常要求分次過濾並監控，防止快速輸注。