# 長期使用phenytoin之癲癇病人主訴新出現複視與步態不穩。Phenytoin濃度28 mcg/mL(治療10-20)。最適當之護理行動為何？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=373129&lang=zh-tw  
> language: zh-TW  
> subject: NCLEX-RN  
> category: PPT

## 題目

長期使用phenytoin之癲癇病人主訴新出現複視與步態不穩。Phenytoin濃度28 mcg/mL(治療10-20)。最適當之護理行動為何？

## 選項

1. 維持現劑量；症狀與phenytoin無關。
2. 暫停下一劑並通報醫師，將病人列入跌倒預防，評估眼震與共濟失調。 **✔ 正確答案**
3. 將下一劑加倍以更快將濃度回到治療範圍。
4. 立即給予活性碳以吸附過量藥物。

**正確答案: 2**

## 解析

Phenytoin治療範圍10-20 mcg/mL。28為中毒。經典中毒表現：眼震(最早期徵象)、複視、共濟失調、口齒不清、意識混亂。行動：暫停劑量、通報醫師調整劑量、加入跌倒預防、完成神經學評估。劑量加倍(3)危險；活性碳(4)不適合慢性中毒(用於攝入~1小時內之急性過量)。

## 深入解析

Phenytoin濃度與徵象常考：10-20治療、20-30眼震+複視+共濟失調、30-40嗜睡、>40昏迷/發作(矛盾性)。最早可偵測之徵象為水平側視時眼震 — 應例行評估。

## 臨床情境

**長期使用phenytoin病人**主訴**新出現複視與步態不穩**。Phenytoin濃度**28 mcg/mL**(治療10-20)。生命徵象穩定，無活動性發作。

## 重要概念

- **Phenytoin治療濃度** — 10-20 mcg/mL；治療指數狹窄需例行TDM與中毒評估。
- **Phenytoin中毒進程** — 20-30眼震/複視/共濟失調、30-40嗜睡、>40昏迷或矛盾性發作。
- **例行眼震評估** — 慢性phenytoin病人每班檢查水平側視 — 最早期中毒徵象。

## 相同主題題目

- [A patient with severe contamination obsessive-compulsive disorder is starting exposure and…](https://mymerci.kr/pages/nclex_q.php?qn_id=372864&lang=zh-tw)
- [A nurse is providing HPV vaccine education to the parent of an 11-year-old at a routine we…](https://mymerci.kr/pages/nclex_q.php?qn_id=372865&lang=zh-tw)
- [An 82-year-old patient with moderate Alzheimer dementia becomes increasingly agitated, res…](https://mymerci.kr/pages/nclex_q.php?qn_id=372904&lang=zh-tw)
- [An adult patient has been seizing continuously for 6 minutes. The provider asks the nurse …](https://mymerci.kr/pages/nclex_q.php?qn_id=373126&lang=zh-tw)
- [Four patients arrive in the ED. Which patient presentation indicates a hypertensive EMERGE…](https://mymerci.kr/pages/nclex_q.php?qn_id=373127&lang=zh-tw)
- [A patient has a serum potassium of 2.8 mEq/L and a new order for IV potassium chloride 40 …](https://mymerci.kr/pages/nclex_q.php?qn_id=373128&lang=zh-tw)
- [The night-shift nurse receives a telephone order from the on-call provider for "morphine 4…](https://mymerci.kr/pages/nclex_q.php?qn_id=373130&lang=zh-tw)
- [A 72-year-old presents to the ED with sudden right-sided weakness and aphasia. Family stat…](https://mymerci.kr/pages/nclex_q.php?qn_id=373516&lang=zh-tw)

## 以其他語言閱讀

- [en](https://mymerci.kr/pages/nclex_q.php?qn_id=373129&lang=en)
- [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=373129&lang=ko)
- [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=373129&lang=ja)
- [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=373129&lang=zh-tw)
- [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=373129&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。_