— 生理適應 · HARD · MCQ —
護理師照護一位血鉀濃度 6.2 mEq/L 的病人，優先採取哪項行動？
A nurse is caring for a client with a potassium level of 6.2 mEq/L. Which action is the priority?
- AObtain a repeat serum potassium level抽取重複的血清鉀濃度檢測
- BPlace the client on a cardiac monitor✓ 正解將病人連接心電圖監測儀
- CAdminister IV insulin and dextrose靜脈注射胰島素與葡萄糖
- DEncourage oral fluid intake鼓勵病人攝取口服液體
— Explanation · 中文詳解 —
高血鉀症（Hyperkalemia）是極度危險的電解質紊亂，血鉀 6.2 mEq/L 屬於中度至重度異常，隨時可能引發致命性的心律不整（如心室顫動或心搏停止）。護理師的第一任務是確保病人安全，透過連續性心電圖（ECG）監測監控心律變化。在確認心律穩定後，才進行藥物介入，如給予胰島素與葡萄糖以促進鉀離子進入細胞內。
Potassium levels of 6.2 mEq/L indicate severe hyperkalemia, which poses an immediate risk of life-threatening cardiac dysrhythmias such as ventricular fibrillation. Therefore, placing the client on a cardiac monitor is the priority action to ensure continuous observation of heart rhythm stability before initiating pharmacological interventions like insulin and dextrose.