— 生理適應 · MEDIUM · MCQ —
護理師照護高血鉀患者，應優先辨識何種檢驗發現？
A nurse is caring for a client with hyperkalemia. Which diagnostic finding is most critical for the nurse to identify?
- AShortened QT intervalQT 間期縮短
- BFlattened P wavesP 波平坦
- CPeaked T waves on ECG✓ 正解心電圖上出現尖聳 T 波
- DST segment depressionST 段下降
— Explanation · 中文詳解 —
高血鉀（Hyperkalemia）對心肌細胞膜電位有顯著影響，最早期且關鍵的徵象是心電圖上出現 T 波尖聳（Peaked T waves）。隨著血鉀升高，會進一步導致 PR 間期延長、QRS 波變寬，最終可能引發心室顫動（Ventricular fibrillation）或心跳停止。因此，識別心電圖變化是護理師照護高血鉀病人的核心責任。
Peaked T waves are the earliest and most critical electrocardiographic sign of hyperkalemia, indicating potential cardiac instability. Recognizing this change allows for immediate intervention to prevent progression to life-threatening arrhythmias such as ventricular fibrillation.