# 一名護理師正在照顧一位因重度子癇前症而接受靜脈注射硫酸鎂的28歲、懷孕36週的初產婦。哪一項發現需要護理師立即停止硫酸鎂輸注？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=505802&lang=zh-tw  
> language: zh-TW  
> subject: Pharmacological and Parenteral Therapies  
> category: PPT

## 題目

一名護理師正在照顧一位因重度子癇前症而接受靜脈注射硫酸鎂的28歲、懷孕36週的初產婦。哪一項發現需要護理師立即停止硫酸鎂輸注？

## 選項

1. 髕骨反射2+且呼吸速率16次/分
2. 尿量40 mL/小時且血壓150/95 mm Hg
3. 髕骨反射消失且呼吸速率10次/分 **✔ 正確答案**
4. 深部肌腱反射3+且有陣攣

**正確答案: 3**

## 解析

髕骨反射消失和呼吸速率10次/分表示硫酸鎂中毒，可能進展為呼吸停止。護理師必須立即停止輸注、提供呼吸支持、通知醫師，並依醫囑準備葡萄糖酸鈣。髕骨反射2+和呼吸速率16次/分為正常發現。尿量40 mL/小時為足夠，血壓150/95 mm Hg雖升高但不表示中毒。深部肌腱反射3+和陣攣表示中樞神經系統易怒性，而非鎂中毒。

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