# 情境 45歲術後個案接受IV morphine後出現全身搔癢與面部潮紅，無皮疹、無水腫、無喘鳴，BP與SpO2正常。個案與家屬擔心是過敏。最佳護理回應為何?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375146&lang=zh-tw  
> language: zh-TW  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PA

## 題目

情境 45歲術後個案接受IV morphine後出現全身搔癢與面部潮紅，無皮疹、無水腫、無喘鳴，BP與SpO2正常。個案與家屬擔心是過敏。最佳護理回應為何?

## 選項

1. 立即停止morphine輸注，並通知醫療提供者可能發生過敏反應；在永久健康記錄中記錄真正的morphine過敏，以防止未來再次接觸，請求開立抗組織胺藥物如diphenhydramine 25–50 mg IV，並密切監測任何過敏性休克徵象，包括呼吸窘迫或低血壓。
2. 此最可能為morphine常見的非過敏性組織胺釋放，可考慮diphenhydramine 25 mg IV，若持續則放慢輸注或改用fentanyl/hydromorphone等合成鴉片，並持續監測真正過敏徵象(隆起風團、血管性水腫、支氣管攣縮、低血壓)。 **✔ 正確答案**
3. 安撫個案，全身性搔癢是morphine常見的副作用，且通常無需治療即可消退；建議非藥物性舒適措施，例如使用冷敷、保持皮膚濕潤、避免穿著粗糙布料，並以目前速率繼續輸注morphine。
4. 將全身性搔癢解釋為止痛不足的徵象，因為未受控制的疼痛會增強交感神經系統活動而導致搔癢；增加morphine輸注速率以達到更好的疼痛控制，預期隨著舒適度改善搔癢會消退，並持續監測呼吸抑制情況。

**正確答案: 2**

## 解析

Morphine與其他天然鴉片(codeine、meperidine)會直接刺激肥大細胞釋放組織胺(非免疫性)，造成搔癢、潮紅、出汗、類似蕁麻疹反應，但無隆起風團、血管性水腫、支氣管攣縮或血流動力改變。並非IgE介導的真正過敏，通常無需永久避免，但會引起不適。鑑別：(1) 非過敏性組織胺釋放 — 對稱搔癢、輕微潮紅、無呼吸/循環影響、一過性不進展；(2) 真正過敏 — 隆起風團、血管性水腫、喘鳴或stridor、低血壓、過敏性休克，需立即epinephrine、永久避免、病歷記錄並改為結構不同的鴉片。組織胺搔癢處置：diphenhydramine 25~50 mg PO/IV、放慢輸注、若持續改用組織胺釋放少的合成鴉片(fentanyl、hydromorphone、oxycodone、methadone)。永久標示過敏與給予aspirin皆錯誤；增加劑量會惡化組織胺釋放。

## 深入解析

血流動力正常的搔癢是組織胺釋放，不是過敏。持續時改用fentanyl/hydromorphone，真正的urticaria-angioedema-wheeze-低血壓才標示過敏。

## 重要概念

- **opioid-induced histamine release** — 天然鴉片直接刺激肥大細胞，非免疫性，引起搔癢/潮紅但無呼吸道影響
- **true opioid allergy** — IgE介導，蕁麻疹/血管水腫/支氣管攣縮/低血壓，需epinephrine並改為其他類別
- **synthetic opioid switch** — fentanyl、hydromorphone、oxycodone、methadone，組織胺釋放較少

## 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 is admitted to the emergency department after ingesting an unknown amount of acet…](https://mymerci.kr/pages/nclex_q.php?qn_id=362720&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)

## 以其他語言閱讀

- [en](https://mymerci.kr/pages/nclex_q.php?qn_id=375146&lang=en)
- [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=375146&lang=ko)
- [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=375146&lang=ja)
- [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=375146&lang=zh-tw)
- [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=375146&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。_