— 生理適應 · MEDIUM · MCQ —
一位慢性腎臟病病人鉀離子濃度為 6.2 mEq/L。護理師預期醫師會優先開立哪種藥物？
A client with chronic kidney disease has a potassium level of 6.2 mEq/L. Which medication should the nurse anticipate the provider will order first?
- ARegular insulin 10 units IV with D50W靜脈注射普通胰島素 10 單位與 D50W
- BIntravenous calcium gluconate✓ 正解靜脈注射葡萄糖酸鈣
- CFurosemide 40 mg IV push靜脈推注 Furosemide 40 mg
- DSodium polystyrene sulfonate聚苯乙烯磺酸鈉
— Explanation · 中文詳解 —
高血鉀且數值 >6.0 mEq/L 時，優先保護心臟肌肉細胞穩定細胞膜，防止致命性心律不整。鈣離子雖不降低血鉀，但能即刻對抗高血鉀對心肌的抑制效果。胰島素與葡萄糖則是用於將鉀離子轉移至細胞內，而非首選的抗心律不整藥物。
The delegation process requires the RN to assess client needs, verify the delegatee's competency, provide clear instructions, and monitor performance. Crucially, the RN must retain responsibility for the nursing process steps of assessment and evaluation, which cannot be delegated to unlicensed assistive personnel.
✦ 台美臨床差異
美國醫院針對高血鉀的緊急處理流程（Calcium first）相當標準化，台灣則視各醫院急診與加護病房規範而定。