# 一名58歲類風濕性關節炎患者已服用prednisone 10 mg每日一次達8個月，突然停藥。三天後，患者出現嘔吐、嚴重虛弱，血壓84/50 mm Hg。檢驗結果顯示鈉128 mEq/L、鉀5.8 mEq/L。護理師應採取哪些措施？請選擇兩項優先措施。

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=505816&lang=zh-tw  
> language: zh-TW  
> subject: Physiological Adaptation  
> category: PA

## 題目

一名58歲類風濕性關節炎患者已服用prednisone 10 mg每日一次達8個月，突然停藥。三天後，患者出現嘔吐、嚴重虛弱，血壓84/50 mm Hg。檢驗結果顯示鈉128 mEq/L、鉀5.8 mEq/L。護理師應採取哪些措施？請選擇兩項優先措施。

護理師應::선택::給予靜脈注射0.9%氯化鈉給予口服prednisone 10 mg檢測血清皮質醇水平給予口服氯化鉀40 mEq和::선택::給予靜脈注射hydrocortisone開始持續dopamine輸注給予靜脈注射氯化鉀給予口服fludrocortisone。

## 解析

患者長期使用糖皮質激素後突然停藥，加上低血壓、嘔吐、虛弱、低血鈉和高血鉀，高度暗示腎上腺危象。優先措施是給予靜脈輸液以矯正低血容量和低血壓，以及給予靜脈注射hydrocortisone以補充不足的糖皮質激素和礦物皮質激素活性。給予口服prednisone不合適，因為患者正在嘔吐且需要快速可靠的吸收。檢測血清皮質醇水平並非優先事項，會延誤救命治療。補充鉀劑會惡化現有的高血鉀。開始dopamine輸注並非第一線介入措施；輸液復甦和類固醇補充才是首要。

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