# 一位慢性腎臟病患者因血清鉀濃度7.2 mEq/L入院。心臟監視器顯示高尖T波和寬QRS波。護理師應首先執行哪項醫囑？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=505803&lang=zh-tw  
> language: zh-TW  
> subject: Pharmacological and Parenteral Therapies  
> category: PPT

## 題目

一位慢性腎臟病患者因血清鉀濃度7.2 mEq/L入院。心臟監視器顯示高尖T波和寬QRS波。護理師應首先執行哪項醫囑？

## 選項

1. 靜脈注射葡萄糖酸鈣 **✔ 正確答案**
2. 靜脈注射常規胰島素和50%葡萄糖
3. 口服聚苯乙烯磺酸鈉
4. 準備緊急血液透析

**正確答案: 1**

## 解析

患者有嚴重高血鉀（7.2 mEq/L）伴隨心電圖變化（高尖T波、寬QRS），表示心臟細胞膜不穩定。靜脈注射葡萄糖酸鈣能立即穩定心臟細胞膜，預防致命性心律不整，因此最優先。胰島素與葡萄糖可將鉀離子移入細胞內，但無立即心臟保護作用。聚苯乙烯磺酸鈉經腸道緩慢移除鉀離子，不適用於急性心電圖變化。血液透析雖為根本治療，但準備需時，必須先給予鈣劑以保護心臟。

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