— 藥理與非經腸給藥 · HARD · MCQ —
一位護理師正在為低血鉀病人靜脈輸注氯化鉀，發現病人過去兩小時尿量僅 10 mL/hr。護理師應採取的最優先措施為何？
A nurse is administering a dose of IV potassium chloride to a client with hypokalemia. The nurse notes the client's urine output has been 10 mL/hr for the last 2 hours. Which action is the priority?
- AIncrease the IV infusion rate to improve renal perfusion加快靜脈輸注速率以改善腎臟灌流
- BObtain a stat serum creatinine level立即抽取血清肌酸酐檢測
- CAdminister a bolus of normal saline給予正常食鹽水衝洗
- DStop the potassium infusion immediately✓ 正解立即停止鉀離子輸注
— Explanation · 中文詳解 —
鉀離子主要經由腎臟排泄，若尿量過少顯示腎功能可能受損，此時繼續輸注鉀離子極易導致高血鉀，進而誘發嚴重心律不整甚至心跳停止。原則上若尿量低於 30 mL/hr 即應暫停，待腎功能評估完成後再行處置。增加輸注或給予食鹽水無法解決潛在的鉀累積風險。
Potassium is excreted by the kidneys, so oliguria indicates impaired renal function and a high risk of life-threatening hyperkalemia. The nurse must stop the infusion immediately if urine output is less than 30 mL/hr.
✦ 台美臨床差異
美台臨床對高危藥物皆採高警訊控管，護理師在缺乏足夠排尿紀錄時，需依據護理標準主動暫停給藥。