— 藥理與非經腸給藥 · MEDIUM · MCQ —
病人因嚴重感染開立萬古黴素（Vancomycin）。下列哪項評估結果需要立即告知醫師？
A client is prescribed vancomycin for a severe infection. Which assessment finding requires immediate notification to the provider?
- ATemperature of 37.8°C體溫 37.8°C
- BDecreased urine output✓ 正解尿量減少
- CMild itching at the IV site靜脈注射部位輕微搔癢
- DFlushing of the face and neck臉部與頸部潮紅
— Explanation · 中文詳解 —
萬古黴素具有高度腎毒性。尿量減少是腎功能受損的早期指標，若發現尿量顯著減少，必須立即停止輸注或調整劑量。選項 D（紅人症）雖需處理但可先減慢輸注速度，C 屬輕微過敏，A 為感染正常病程，腎毒性風險層級最高。
Vancomycin is highly nephrotoxic, making decreased urine output a critical sign of renal impairment that requires immediate provider notification. Although Red Man Syndrome causes flushing, it is typically managed by slowing the infusion rate rather than discontinuing therapy immediately. Low-grade fever is expected with infection, and mild itching can often be managed with antihistamines after assessment.
✦ 台美臨床差異
兩地均重視萬古黴素血中濃度監測（Trough level），美國常規由藥師主導劑量調整，台灣則多由醫師依腎功能指標決策。