Adverse Effects/Contraindications/Interactions

一位 68 歲患有第 2 型糖尿病和第 3 期慢性腎臟病的病人，在 2100 同時有胰島素 degludec 和胰島素 glargine 的醫囑。在處方醫師和藥師澄清差異並記錄一個調整後的基礎處方之前，兩種劑量均未給予。請審查隨後的血糖、攝取量、症狀和藥物清單趨勢。選擇最佳的解釋和持續計畫。

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Time	Data
2030	Glucose 78 mg/dL; 25 percent of dinner eaten; two 2100 basal-insulin orders remain active; client is asymptomatic血糖 78 mg/dL；晚餐吃了 25%；兩個 2100 基礎胰島素醫囑仍有效；病人無症狀
2105	Neither basal dose administered; prescriber and pharmacist notified; glucose 82 mg/dL; client remains asymptomatic兩種基礎劑量均未給予；已通知處方醫師和藥師；血糖 82 mg/dL；病人仍無症狀
2130	Insulin degludec order discontinued; one adjusted insulin glargine order documented and administered胰島素 degludec 醫囑已停用；一個調整後的胰島素 glargine 醫囑已記錄並給予
2300	Glucose 92 mg/dL; no sweating, tremor, palpitations, confusion, or change in mental status血糖 92 mg/dL；無出汗、顫抖、心悸、意識模糊或心智狀態改變
0600	Glucose 110 mg/dL; client ate 60 percent of breakfast; one basal-insulin order remains active血糖 110 mg/dL；病人吃了 60% 的早餐；一個基礎胰島素醫囑仍有效

Q1. How is the client responding after the discrepancy was resolved?差異解決後，病人反應如何？

Developing progressive hypoglycemia despite intervention儘管介入，仍出現進行性低血糖 Stable without hypoglycemia after the duplicate order was removed重複醫囑移除後，穩定且無低血糖 Developing severe hyperglycemia from withholding all insulin因停用所有胰島素而出現嚴重高血糖

Q2. Which ongoing plan is appropriate?哪一個持續計畫是適當的？

Restart both basal-insulin orders at the next scheduled time在下一個預定時間重新開始兩種基礎胰島素醫囑 Stop glucose monitoring because the client has no symptoms停止血糖監測，因為病人沒有症狀 Continue the single reconciled regimen, monitoring, and discharge-list verification繼續單一核對後的處方、監測和出院清單核實 Treat immediately with 15 g glucose despite values above 70 mg/dL and no symptoms儘管血糖值高於 70 mg/dL 且無症狀，仍立即用 15 g 葡萄糖治療

解析

重複醫囑已透過授權澄清移除，一個調整後的基礎處方已給予，且血糖維持在 70 mg/dL 以上，無症狀。持續監測和明確核對的出院計畫是適當的。

相同主題的下一題A client is admitted to the emergency department after ingesting an unknown amount of acet…本題收錄於此題庫[전통+신유형] NCLEX LEVEL UP 패키지KRW 79,000

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Q1. How is the client responding after the discrepancy was resolved?差異解決後，病人反應如何？

Q2. Which ongoing plan is appropriate?哪一個持續計畫是適當的？

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