— 藥理與非經腸給藥 · HARD · MCQ —
病人服用呋塞米（Furosemide）40 mg 每日一次。下列哪項發現最須優先回報醫師？
A client is prescribed furosemide 40 mg PO daily. Which finding is the most critical to report to the provider?
- AWeight loss of 1 lb in 24 hours24小時內體重減輕1磅
- BSerum potassium of 3.1 mEq/L✓ 正解血清鉀濃度為3.1 mEq/L
- CBlood pressure of 110/70 mmHg血壓為110/70 mmHg
- DReport of nocturia主訴夜間多尿
— Explanation · 中文詳解 —
呋塞米為強效利尿劑，會導致鉀離子大量排出。鉀離子數值 3.1 mEq/L 屬於低血鉀，這會大幅增加毛地黃毒性風險並引發致命性心律不整。相較之下，體重下降與夜尿為藥物的正常預期效應，血壓 110/70 mmHg 亦屬穩定範圍。
Furosemide is a potent loop diuretic that promotes significant potassium excretion, making hypokalemia a major adverse effect. A serum potassium level of 3.1 mEq/L indicates hypokalemia, which significantly increases the risk of life-threatening cardiac arrhythmias and digoxin toxicity. While weight loss and nocturia are expected effects of diuresis, and the blood pressure is stable, the electrolyte imbalance requires immediate provider notification.
✦ 台美臨床差異
臨床上對電解質異常的監測與補鉀規範，美國護理師常有獨立給藥權限調整補鉀量（Protocol），台灣多需醫師確認後給藥。