# 病人血清鉀2.8 mEq/L，新醫囑靜脈potassium chloride 40 mEq。哪一項護理行動反映安全之靜脈鉀投與？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=373128&lang=zh-tw  
> language: zh-TW  
> subject: NCLEX-RN  
> category: PPT

## 題目

病人血清鉀2.8 mEq/L，新醫囑靜脈potassium chloride 40 mEq。哪一項護理行動反映安全之靜脈鉀投與？

## 選項

1. 於周邊路徑以IV push於2分鐘內推入40 mEq。
2. 以輸液幫浦於周邊路徑每小時不超過10 mEq、中央路徑每小時不超過20 mEq；絕對不可IV push。 **✔ 正確答案**
3. 將40 mEq加入50 mL生理食鹽水之注射筒，以注射筒幫浦於30分鐘內注入。
4. 將鉀與胰島素及葡萄糖混合以加速移入細胞內。

**正確答案: 2**

## 解析

靜脈potassium chloride為高警示藥。絕不可IV push — 引發致命心律不整，為ISMP經典之「不可使用」實務。標準限制：周邊每小時≤10 mEq(超過引起靜脈炎)、中央每小時≤20 mEq(於加護單位連續監測下可更高)，永遠使用輸液幫浦，永遠使用預混袋(不可使用注射筒推注)，嚴重缺乏時連續心電監測，給藥後重測K+。

## 深入解析

IV push鉀=致命 — 為僅次於胰島素與heparin之NCLEX用藥安全最常考情境。ISMP與Joint Commission反覆指出IV push KCl為造成sentinel event之實務。僅預混袋、僅輸液幫浦，絕不可使用注射筒。

## 臨床情境

內外科病房成人病人，血清K+ **2.8 mEq/L**。新醫囑：**靜脈potassium chloride 40 mEq**。病人於右前臂有18號周邊靜脈導管。

## 重要概念

- **靜脈potassium chloride** — 高警示電解質補充；IV push致命，必須以幫浦稀釋輸注。
- **周邊 vs 中央輸注限制** — 周邊每小時≤10 mEq(受靜脈炎限制)；中央每小時≤20 mEq加心臟監測。
- **ISMP「禁止使用」 — IV push鉀** — ISMP列為never-event；床邊與藥局雙重核對政策強制僅供應預混袋。

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