一位每天抽一包菸的35歲女性，最近剛被開立了複合型口服避孕藥 (COCs)。一週後，她打電話到診所諮詢專線，報告右小腿肚子有壓痛、輕微腫脹，並且走路時會痛。她對此不以為意，認為可能只是新鞋子引起的抽筋。護理師的首要處置為何？
A 35-year-old female who smokes one pack of cigarettes per day was recently prescribed combined oral contraceptives (COCs). One week later, she calls the clinic advice line to report right calf tenderness, mild swelling, and pain when walking. She dismisses it as a possible muscle cramp from new shoes. What is the nurse's priority action?
- AAdvise the client to massage the calf vigorously to break up any muscle spasms resulting from the new footwear.建議客戶用力按摩小腿以緩解新鞋引起的肌肉痙攣。
- BInstruct the client to immediately stop taking the pills and report to the emergency department for an ultrasound evaluation.✓ 正解指示客戶立即停止服用藥丸，並前往急診進行超音波檢查。
- CReassure the client that mild fluid retention is a common benign side effect as the body adjusts to the added estrogen.安撫客戶，表示輕微的水份滯留是身體適應額外雌激素時常見的良性副作用。
- DInstruct her to elevate the affected leg above the heart, apply an ice pack, and call back tomorrow if it doesn't improve.指示她將患肢抬高至心臟以上，並敷冰塊，若無改善則於明日再行聯繫。
本題測試避孕藥與危險因子的健康維護。複合型口服避孕藥 (含有雌激素與黃體素) 最大的潛在致命併發症是極高的血栓形成機率。該名婦女不僅超過 35 歲，且為重度吸菸者 (每天一包)，這兩項合併使得她罹患深部靜脈栓塞（DVT）與肺心病（如肺栓塞 PE 及中風）的風險呈指數級飆升。患者所抱怨的單側小腿壓痛（Calf tenderness）、腫脹及行走時疼痛，是經典的 DVT 典型臨床表徵。護理的最高優先原則絕對是保護生命免於血栓剝落，因此必須命令病患立刻停藥、保持冷靜別動腿，並前往急診室接受超音波（Doppler ultrasound）等醫療評估以排除 DVT（選項B正確）。選項C將致死的血栓誤導為良性水分滯留；選項D雖然抬高患肢看似正確，但讓病患留在家中拖延會引發致命肺栓塞；選項A「用力按摩小腿」絕對是 DVT 的禁忌，這在物理上會直接把成形的血塊推入靜脈血液循環中，射向肺動脈導致幾分鐘內猝死。
The combination of estrogen-containing oral contraceptives, smoking, and age over 35 creates a profound hypercoagulable state, significantly increasing the risk of deep vein thrombosis (DVT). The client’s unilateral calf pain and swelling are classic signs of DVT, requiring immediate cessation of the medication and emergency evaluation to prevent life-threatening pulmonary embolism.
「35歲以上抽菸婦女禁用含雌激素的口服避孕藥」是全球醫學界的鐵律。這題也是著名的護理常識陷阱：「按摩小腿」這個直覺動作會直接把血栓送入肺動脈（引發 Pulmonary Embolism）致人於死地，在台美臨床皆是不斷被打底的防護概念。