# 一位護理師正在教導一位剛被開立丙戊酸（valproate）的個案，關於需要立即通知醫師的症狀。護理師應強調哪一組症狀？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391745&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一位護理師正在教導一位剛被開立丙戊酸（valproate）的個案，關於需要立即通知醫師的症狀。護理師應強調哪一組症狀？

## 選項

1. 第一個月體重增加1-2磅
2. 第一週短暫輕微嗜睡
3. 持續腹痛、嘔吐、食慾不振、黃疸或容易瘀青 **✔ 正確答案**
4. 刷牙時輕微牙齦出血

**正確答案: 3**

## 解析

正確 (2)：丙戊酸具有針對肝毒性（厭食、嘔吐、黃疸、因凝血功能受損而易瘀傷）和胰臟炎（嚴重腹痛、嘔吐）的黑框警示。這兩者皆可能危及生命，需要立刻進行肝功能檢查、脂肪酶與氨的評估。 (1) 輕微牙齦出血可能由任何原因引起，單獨出現時並非警示徵兆。 (3) 有些體重增加是預期中的。 (4) 治療初期輕微嗜睡是常見且會自行緩解的。

## 深入解析

記憶提示 Valproate “VALPro”紅旗：Vomiting、Anorexia、Liver黃疸、Pancreatitis腹痛。CPG 基線LFT、ammonia、血小板並定期追蹤。

## 臨床情境

情境 31歲女性，因雙相情緒障礙開始valproic acid 500 mg PO BID。正在接受門診紅旗不良反應衛教。

## 重要概念

- **肝毒性** — 藥物引起的肝損傷；valproate黑框警告，2歲以下兒童與多重治療風險特別高。
- **胰臟炎** — 胰臟發炎；valproate罕見但嚴重的不良反應，需停藥。
- **高血氨** — Valproate抑制尿素循環造成血氨升高；即使LFT正常也可能導致腦病變。

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