# 一位患有心臟衰竭和腎臟疾病的客戶正在接受碳酸氫鈉。觀察到新的囉音、頸靜脈怒張、水腫和鈉 152 mEq/L。哪項行動是優先事項？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=513959&lang=zh-tw  
> language: zh-TW  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## 題目

一位患有心臟衰竭和腎臟疾病的客戶正在接受碳酸氫鈉。觀察到新的囉音、頸靜脈怒張、水腫和鈉 152 mEq/L。哪項行動是優先事項？

## 選項

1. 根據規範停止或暫停輸注，評估呼吸和循環，並通知授權的臨床醫師。 **✔ 正確答案**
2. 增加輸注速率以更快地糾正酸鹼失衡。
3. 未經醫囑給予額外的含鈉液體。
4. 將發現記錄為預期情況，並在出院時重新評估。

**正確答案: 1**

## 解析

客戶出現鈉和體積相關的毒性。防止進一步暴露，評估心肺狀態，並升級以進行處方管理。

## 深入解析

快速解答
中斷進一步的鈉負荷，並處理 伴有高血鈉的體液過量。

為什麼這是正確的
碳酸氫鈉可能導致鈉滯留、水腫、體液過量、高血鈉和代謝性鹼中毒。心臟衰竭和腎臟疾病會增加脆弱性。

簡單類比或心像
當溢流警報已經響起時，不要繼續注滿水庫。

記憶點
碳酸氫鹽增加鈉：囉音和鈉升高需要採取行動。

NCLEX 決策規則
當治療造成呼吸或電解質損害時，應停止進一步暴露、穩定、評估並通知，而不是更快地追逐原始問題。

為什麼其他選項是錯誤的
更快的輸注和更多的鈉會使機制惡化；單獨延遲記錄並不能保護客戶。參考資料
1DailyMed: Sodium Bicarbonate Injection鈉滯留、體液過量和電解質監測

## 臨床情境

鈉負荷監測
追蹤肺音、氧合、水腫、攝入量和排出量、鈉、酸鹼狀態和累積鈉來源。

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