# 一位老年患者新開了 diazepam 5 mg 口服睡前服用以治療失眠。哪一項護理處置是最優先的？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391724&lang=zh-tw  
> language: zh-TW  
> subject: Crisis Intervention  
> category: PSI

## 題目

一位老年患者新開了 diazepam 5 mg 口服睡前服用以治療失眠。哪一項護理處置是最優先的？

## 選項

1. 暫緩給藥，並聯絡開立處方者討論Beers Criteria的疑慮與較安全的替代方案。 **✔ 正確答案**
2. 給予此劑量，並教導個案夜間使用呼叫鈴。
3. 將錠劑磨碎並混入蘋果醬以方便吞嚥。
4. 只有在收縮壓低於100 mmHg時才暫緩用藥。

**正確答案: 1**

## 解析

正確 (1)：Diazepam 被列入 Beers Criteria 中對 ≥65 歲成人可能不適當的用藥清單，因為其長半衰期的活性代謝物會蓄積，顯著增加跌倒、髖部骨折和譫妄的風險。護理師應暫停給藥，並向開立處方者建議更安全的替代方案（行為介入措施、ramelteon 或低劑量 trazodone）。(2) 僅進行病人衛教無法消除藥物相關的跌倒風險。(3) 血壓並非相關的安全參數；鎮靜程度和步態穩定性才是。(4) 磨碎藥錠並不會改變潛在的藥理風險。

## 深入解析

Memory Tip: Old + benzo = Beers bad.

## 臨床情境

Scenario A 78-year-old female with new-onset insomnia was prescribed diazepam 5 mg PO HS; moderate-to-high fall risk.

## 重要概念

- **Beers Criteria** — AGS list of medications potentially inappropriate for adults ≥65.
- **Long half-life metabolite** — An active byproduct of drug metabolism that persists longer than the parent drug.
- **Fall risk** — Probability of an unintentional fall, increased by sedating drugs.

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