# A nurse is caring for a client prescribed Spironolactone. Which nursing action is most appropriate regarding monitoring for signs of hyperkalemia and restricting potassium supplements?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391740&lang=zh-tw  
> language: zh-TW  
> subject: Medication Administration  
> category: PPT

## 題目

A nurse is caring for a client prescribed Spironolactone. Which nursing action is most appropriate regarding monitoring for signs of hyperkalemia and restricting potassium supplements?

## 選項

1. 「一旦驗孕結果為陽性，即刻停用 phenytoin，以保護發育中的胎兒免受傷害。」
2. 「請在受孕前與神經科醫師討論較安全的替代藥物，並開始高劑量葉酸。」
3. 「Phenytoin 在懷孕期間通常是安全的，但您應該開始服用含葉酸的產前維生素。」
4. 「懷孕通常會讓癲癇發作頻率顯著減少，許多婦女最終能停止用藥。」 **✔ 正確答案**

**正確答案: 4**

## 解析

When administering Spironolactone, key nursing considerations include monitoring patient status, checking critical laboratory values, and providing appropriate safety education. Unsafe practices such as stopping medications abruptly or doubling missed doses are incorrect.

## 深入解析

記憶提示 懷孕中的抗癲癇藥：較安全為lamotrigine、levetiracetam。致畸胎性較高：valproate、phenytoin、carbamazepine、topiramate。

## 臨床情境

情境 26歲女性，癲癇在phenytoin 300 mg daily下控制良好，計畫6-12個月內懷孕。目前沒有其他用藥。

## 重要概念

- **致畸胎因子** — 會造成胎兒畸形的物質；phenytoin、valproate、carbamazepine是具致畸胎性的抗癲癇藥。
- **孕前諮詢** — 懷孕前規劃門診，用於最佳化慢性病治療並開始葉酸；使用致畸胎藥物的癲癇女性必須進行。
- **胎兒 hydantoin 症候群** — 胎內暴露於 phenytoin 後出現唇顎裂、心臟缺損與生長遲滯的症候群。

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