# 護理師正準備為癲癇重積狀態靜脈注射phenytoin。哪一項準備與給藥措施對安全至關重要？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391738&lang=zh-tw  
> language: zh-TW  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## 題目

護理師正準備為癲癇重積狀態靜脈注射phenytoin。哪一項準備與給藥措施對安全至關重要？

## 選項

1. 只與生理食鹽水混合，經大靜脈以不超過50 mg/min輸注，並持續監測ECG **✔ 正確答案**
2. 為快速控制癲癇，30秒內IV bolus推注
3. 與 D5W 混合，經任何可用靜脈管路以100 mg/min輸注
4. 與正在輸注KCl的Y-site同時給藥

**正確答案: 1**

## 解析

正確答案(2)：靜脈注射phenytoin在含葡萄糖的溶液中會產生沉澱，必須使用0.9%生理食鹽水。最大給藥速率：50 mg/min（年長者或心臟病患為25 mg/min），以避免低血壓、心搏過緩和心律不整。需持續監測心電圖和血壓。使用大靜脈注射以減少紫手套症候群（滲漏→軟組織缺血）。 (1) D5W會導致沉澱；100 mg/min是危險的。 (3) 快速推注會導致心臟停止。 (4) Y型管與氯化鉀共同給藥有沉澱風險。

## 深入解析

記憶提示 IV phenytoin：生理食鹽水、慢速、大靜脈、ECG。fosphenytoin 是較安全替代藥，水溶性、可較快輸注且局部傷害較少。

## 臨床情境

情境 38歲病人處於癲癇重積狀態；醫囑給予phenytoin 1000 mg IV負荷劑量。病人有一條18G肘窩專用靜脈管路。

## 重要概念

- **紫手套症候群** — phenytoin 外滲造成肢體缺血與變色；處置為停止輸注並抬高肢體。
- **Fosphenytoin** — phenytoin 的水溶性前驅藥；IV/IM較安全，可允許較快速率150 mg PE/min。
- **癲癇重積狀態** — 癲癇發作持續超過5分鐘，或反覆發作且中間未恢復；需快速給予抗癲癇負荷劑量的急症。

## 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=391738&lang=en)
- [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=391738&lang=ko)
- [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=391738&lang=ja)
- [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=391738&lang=zh-tw)
- [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=391738&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。_