# 一名病人在約4小時前服用了不明量的乙醯胺酚後被收治於急診。血清乙醯胺酚濃度高於Rumack-Matthew列線圖的治療線。為預防肝毒性,護理師應預期投與哪一種藥物? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=362720&lang=zh-tw > language: zh-TW > subject: Adverse Effects/Contraindications/Interactions > category: PPT ## 題目 一名病人在約4小時前服用了不明量的乙醯胺酚後被收治於急診。血清乙醯胺酚濃度高於Rumack-Matthew列線圖的治療線。為預防肝毒性,護理師應預期投與哪一種藥物? ## 選項 1. 納洛酮 2. N-乙醯半胱胺酸(NAC) **✔ 正確答案** 3. 維生素K 4. 活性炭 **正確答案: 2** ## 解析 NAC是麩胱甘肽的前驅物,可中和乙醯胺酚的毒性代謝物NAPQI,預防肝細胞壞死。服用後8小時內最有效,24小時內仍有益處。納洛酮為類鴉片拮抗劑,維生素K為warfarin的逆轉劑,活性炭僅在服用後1小時內有效。 ## 深入解析 臨床判斷 Rumack-Matthew列線圖是乙醯胺酚中毒治療的依據。4小時時若高於治療線,即有肝毒性風險,需立即投與N-乙醯半胱胺酸(NAC)。活性炭在服用1小時後效果有限。 記憶口訣 APAP中毒 → NAC(NAC中和毒素) 韓 vs 美 美國標準: 靜脈NAC 21小時方案(150mg/kg負荷+50+100)。臺灣亦以靜脈NAC為主。 ## 臨床情境 臨床指引 美國醫療毒物學會(ACMT)與AASLD建議,Rumack-Matthew列線圖治療線以上者應靜脈投與NAC。標準劑量: 150 mg/kg負荷(60分鐘),續50 mg/kg於4小時,再100 mg/kg於16小時。 注意 活性炭僅於服用1小時內有效。之後應優先投與NAC;若超過治療線,不可等待重複血中濃度再投藥。 ## 重要概念 - **N-乙醯半胱胺酸(NAC)** — 麩胱甘肽的前驅物,可結合並解毒乙醯胺酚的毒性代謝物NAPQI。為乙醯胺酚中毒的標準解毒劑。靜脈方案: 150 mg/kg負荷→50 mg/kg於4小時→100 mg/kg於16小時。 - **NAPQI(N-乙醯-p-苯醌亞胺)** — 當乙醯胺酚超過麩胱甘肽結合能力時所產生的毒性中間代謝物。若未解毒會造成中心小葉肝細胞壞死。 - **Rumack-Matthew列線圖** — 將血清乙醯胺酚濃度與服用後時間(4-24小時)對應的圖表。治療線於4小時時150 mcg/mL起,超過此線即需NAC治療。 ## 相同主題題目 - [A nurse is reviewing the morning lab results for an adult client receiving warfarin for at…](https://mymerci.kr/pages/nclex_q.php?qn_id=360515&lang=zh-tw) - [A client with chronic heart failure is prescribed metoprolol 25 mg orally twice daily. Bef…](https://mymerci.kr/pages/nclex_q.php?qn_id=362756&lang=zh-tw) - [A 28-year-old client with type 1 diabetes receives regular insulin 6 units and NPH insulin…](https://mymerci.kr/pages/nclex_q.php?qn_id=362792&lang=zh-tw) - [A client receives IV vancomycin 1 g every 12 hours for MRSA bacteremia. Before the next do…](https://mymerci.kr/pages/nclex_q.php?qn_id=362833&lang=zh-tw) - [A client with bipolar disorder has been taking lithium carbonate 600 mg orally three times…](https://mymerci.kr/pages/nclex_q.php?qn_id=362894&lang=zh-tw) - [An 80-year-old male with heart failure is prescribed digoxin 0.125 mg daily. During mornin…](https://mymerci.kr/pages/nclex_q.php?qn_id=372686&lang=zh-tw) - [A 38-year-old female with rheumatoid arthritis is being discharged with a new prescription…](https://mymerci.kr/pages/nclex_q.php?qn_id=372687&lang=zh-tw) - [A 62-year-old patient is being discharged after a deep vein thrombosis and will continue e…](https://mymerci.kr/pages/nclex_q.php?qn_id=372707&lang=zh-tw) ## 以其他語言閱讀 - [en](https://mymerci.kr/pages/nclex_q.php?qn_id=362720&lang=en) - [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=362720&lang=ko) - [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=362720&lang=ja) - [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=362720&lang=zh-tw) - [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=362720&lang=vi) --- More free questions: [NCLEX-RN 題庫](https://mymerci.kr/pages/nclex_bank.php?lang=zh-tw) _僅供學習參考。實際臨床請遵循最新指引與所屬機構規範。_