— 生理適應 · HARD · MCQ —
一位急性胰臟炎病患目前禁食（NPO）並靜脈輸液治療，哪一項評估發現需要護理師立即介入？
A client with acute pancreatitis is NPO and receiving IV fluids. Which assessment finding requires immediate nursing intervention?
- AAbsent bowel sounds in all four quadrants四個象限均無腸鳴音
- BInspiratory crackles in the lung bases✓ 正解肺底有捻发音
- CBlood glucose level of 250 mg/dL血糖值 250 mg/dL
- DSerum amylase level of 400 U/L血清澱粉酶值 400 U/L
— Explanation · 中文詳解 —
急性胰臟炎常見全身性併發症為肺部問題，包括肺積水、肺塌陷或 ARDS。兩側肺底囉音（crackles）暗示可能出現肺水腫或過度輸液導致的心肺負擔，需優先處理以免呼吸衰竭。A 為疾病進程表現，A 為禁食常見現象，C 雖然異常但非立即致命危險。
Acute pancreatitis can lead to serious systemic complications, including pulmonary issues such as pleural effusion, atelectasis, or acute respiratory distress syndrome (ARDS). The presence of inspiratory crackles at the lung bases suggests fluid overload or pulmonary edema, which poses an immediate threat to respiratory function and requires prompt intervention.
✦ 台美臨床差異
無明顯差異，兩地皆強調急性胰臟炎的液體復甦與併發症監測。