病人正接受靜脈輸注氯化鉀 20 mEq 於 100 mL 生理食鹽水。護理師觀察到輸注部位出現紅斑、水腫且觸感冰涼。護理師應優先採取何項措施？
A client is receiving an intravenous infusion of potassium chloride 20 mEq in 100 mL of 0.9% Normal Saline. The nurse notes the infusion site is erythematous, edematous, and cool to the touch. Which action should the nurse take first?
- AFlush the IV line to ensure patency沖洗靜脈通路以確保暢通
- BApply a warm compress to the site在該部位敷溫毛巾
- CStop the infusion immediately✓ 正解立即停止輸注
- DNotify the healthcare provider通知醫療保健提供者
氯化鉀（Potassium Chloride）屬於高警訊藥物（high-alert medication），具有強烈的刺激性。當輸注部位出現紅斑、水腫且觸感冰涼時，顯示藥物已外滲（infiltration）至皮下組織。若繼續輸注，可能導致化學性蜂窩性組織炎甚至組織壞死。護理師的第一反應必須是立即停止輸注，以防止更多藥物進入受損部位，隨後再執行拔除導管與後續評估。
The nurse must immediately stop the infusion because signs of erythema, edema, and coolness indicate potassium chloride extravasation, which can cause severe tissue necrosis. Potassium chloride is a high-alert medication with strong irritant properties, so halting administration is the priority to prevent further chemical injury to the surrounding tissues.