— 藥理與非經腸給藥 · MEDIUM · MCQ —
病人正在進行肝素（Heparin）靜脈輸注，護理師發現 aPTT 值為 110 秒。護理師應優先執行下列何項措施？
A client is receiving an intravenous infusion of heparin. The nurse notes that the client’s aPTT is 110 seconds. Which action should the nurse take first?
- AStop the heparin infusion✓ 正解停止肝素輸注
- BContinue the infusion at the same rate以相同速率繼續輸注
- CNotify the laboratory to repeat the test通知實驗室重複檢測
- DAdminister protamine sulfate給予硫酸魚精蛋白
— Explanation · 中文詳解 —
肝素（Heparin）治療的目標 aPTT 通常為對照值的 1.5 到 2.5 倍。當數值達到 110 秒時（遠高於一般臨床目標），表示抗凝血效果過強，出血風險極高。首要動作應為立即暫停輸注，隨後再評估是否需要使用拮抗劑（Protamine sulfate）。護理師必須熟悉此類藥物的監測數值與處置標準，以確保病人安全。
An aPTT of 110 seconds indicates excessive anticoagulation and a high risk of hemorrhage, far exceeding the therapeutic range. The nurse's first action must be to stop the heparin infusion to prevent further bleeding, then notify the provider for potential administration of protamine sulfate.