# 一名因重度氣喘使用高劑量吸入fluticasone 1000 mcg/日加每日prednisone 7.5 mg的病人，在類流感疾病後出現發燒、嘔吐與低血壓。優先護理行動是什麼？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391774&lang=zh-tw  
> language: zh-TW  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## 題目

一名因重度氣喘使用高劑量吸入fluticasone 1000 mcg/日加每日prednisone 7.5 mg的病人，在類流感疾病後出現發燒、嘔吐與低血壓。優先護理行動是什麼？

## 選項

1. 給予IV補鉀
2. 預期給予IV hydrocortisone、IV normal saline與dextrose，因疑似腎上腺危象 **✔ 正確答案**
3. 暫停所有氣喘藥並4小時後重新評估
4. 鼓勵口服水分，30分鐘後再測血壓

**正確答案: 2**

## 解析

正解 (2): 長期高劑量ICS加慢性全身性類固醇會造成HPA軸抑制；急性壓力如疾病、嘔吐、手術時若無stress-dose steroid，會誘發腎上腺危象，出現低血壓、低血糖、低鈉、高鉀、虛弱。治療為IV hydrocortisone 100 mg STAT、含dextrose的IV saline與支持治療。(1) 延誤可致命。(3) 腎上腺危象常低Na/高K，補K會惡化。(4) 不足。

## 深入解析

Memory Tip 長期類固醇 + 急性壓力 = Stress dose or Crash。發燒、手術、疾病時需依sick-day rules。CPG 慢性類固醇使用者應配戴MedicAlert並攜帶緊急hydrocortisone。

## 臨床情境

Scenario 48歲女性，因重度氣喘使用高劑量ICS + prednisone 7.5 mg/日 2年。出現發燒、嘔吐、BP 86/52、虛弱、混亂、指尖血糖62。

## 重要概念

- **腎上腺危象** — 急性glucocorticoid不足造成休克、低血糖與電解質異常；需緊急hydrocortisone。
- **HPA軸抑制** — 長期外源性類固醇造成下視丘-腦下垂體-腎上腺軸抑制。
- **Sick-day rules** — 疾病、手術或創傷時增加類固醇壓力劑量以預防危象。

## 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=391774&lang=en)
- [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=391774&lang=ko)
- [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=391774&lang=ja)
- [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=391774&lang=zh-tw)
- [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=391774&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。_