# 一名腎上腺功能不全的病人出現嘔吐、極度虛弱、血壓 78/42 mm Hg 和意識混亂。護理師應首先預期哪一項醫囑？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=394151&lang=zh-tw  
> language: zh-TW  
> subject: Illness Management  
> category: PA

## 題目

一名腎上腺功能不全的病人出現嘔吐、極度虛弱、血壓 78/42 mm Hg 和意識混亂。護理師應首先預期哪一項醫囑？

## 選項

1. 限制所有液體攝入 24 小時。
2. 給予 beta blocker 治療低血壓。
3. 給予高劑量口服鉀補充劑。
4. 依醫囑給予靜脈注射 hydrocortisone 和等張溶液。 **✔ 正確答案**

**正確答案: 4**

## 解析

腎上腺功能不全病人出現低血壓、嘔吐、虛弱和意識混亂，暗示為腎上腺危象。治療包括立即補充糖皮質激素和依醫囑給予等張溶液。延遲類固醇補充可能危及生命。

## 深入解析

臨床判斷
腎上腺危象是一種有休克風險的內分泌急症。

記憶提示
腎上腺危象：類固醇和輸液。

## 臨床情境

臨床實務指引
腎上腺危象的處理重點在於快速補充類固醇、輸液復甦、監測血糖和電解質，以及治療誘發因素。

注意
嘔吐會阻礙口服類固醇的吸收，並增加危象風險。

## 重要概念

- **腎上腺功能不全 (Adrenal Insufficiency)** — 腎上腺激素，特別是皮質醇，分泌不足。
- **Hydrocortisone** — 一種糖皮質激素，用於在腎上腺危象時補充皮質醇。
- **等張溶液 (Isotonic Fluid)** — 張力與血漿相似的靜脈輸液，用於容積復甦。

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