病人正接受靜脈輸注 20 mEq 氯化鉀於 100 mL 生理食鹽水中，預計一小時輸完。護理師應優先監測下列何種發現？
A client is receiving an intravenous infusion of potassium chloride 20 mEq in 100 mL of 0.9% Normal Saline over 1 hour. Which assessment finding is most important for the nurse to monitor?
- ABlood pressure variability血壓變化
- BSite redness and pain during infusion✓ 正解輸注期間注射部位發紅和疼痛
- CRespiratory rate and effort呼吸頻率和努力程度
- DSerum potassium level post-infusion輸注後的血清鉀濃度
氯化鉀具有高度刺激性，極易引起靜脈炎或組織壞死。此題重點在於給藥途徑的安全性（Safety and Infection Control），因該劑量給藥濃度較高，發生輸液外滲或靜脈炎風險極大，故需優先觀察血管通路處的皮膚反應。
Potassium chloride is highly irritating to veins and can cause severe tissue damage if extravasation occurs. Therefore, monitoring the infusion site for redness and pain is the most immediate priority to detect potential complications early. While serum levels and cardiac status are important, they are systemic effects that may not be as rapidly apparent as local tissue injury from a vesicant like potassium.
美台臨床皆嚴格規定鉀離子不可直接靜脈推注，且必須經過稀釋，輸注點皆需謹慎評估。