# 服用 rivaroxaban 的個案出現急性腎損傷。請根據每個發現所支持的用藥決策進行分類。

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522059&lang=zh-tw  
> language: zh-TW  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## 題目

服用 rivaroxaban 的個案出現急性腎損傷。請根據每個發現所支持的用藥決策進行分類。

|  | 支持 rivaroxaban 暴露量改變 | 支持活動性出血 | 支持腎臟或藥物保護 |
| --- | --- | --- | --- |
| 肌酸酐從 0.9 增加到 2.4 mg/dL |  |  |  |
| 尿量減少至 20 mL/小時 |  |  |  |
| 報告有新的黑便 |  |  |  |
| 血紅素從 12.8 減少到 9.7 g/dL |  |  |  |
| 處方醫師和藥師正在審查抗凝血劑計畫 |  |  |  |
| 停用非類固醇消炎止痛藥 (NSAIDs) 和其他可避免的腎毒性藥物 |  |  |  |

## 解析

腎功能快速下降和少尿支持 rivaroxaban 暴露量改變；黑便和血紅素下降支持活動性出血；停用腎毒性藥物並緊急審查劑量或治療支持腎臟和抗凝血劑的安全性。

## 深入解析

快速解答
連結 急性腎衰竭、抗凝血劑暴露量和出血證據。

為什麼這是正確的
rivaroxaban 的仿單指示臨床醫師在發生急性腎衰竭時，應考慮調整劑量或停藥。出血嚴重程度和持續的血栓適應症必須一併評估。

簡單類比或心像
當藥物排出減慢時，暴露量可能會增加；糞便和血紅素顯示是否已經發生傷害。

記憶點
腎功能下降加上出血跡象意味著立即審查抗凝血劑。

NCLEX 決策規則
將腎臟變化線索與直接出血證據和保護性介入措施分開分類。

為什麼其他選項是錯誤的
在腎功能突然惡化後，先前可接受的劑量並非自動安全。References
1DailyMed: Rivaroxaban腎功能不全、急性腎衰竭審查、出血監測以及避免不安全暴露

## 臨床情境

DOAC 腎功能審查
追蹤肌酸酐清除率、尿量、最後劑量、交互作用藥物、出血、血紅素、血流動力學、適應症以及經授權的停藥或替代計畫。

## 相同主題題目

- [A client is admitted to the emergency department after ingesting an unknown amount of acet…](https://mymerci.kr/pages/nclex_q.php?qn_id=362720&lang=zh-tw)
- [A client with chronic heart failure is prescribed metoprolol 25 mg orally twice daily. Bef…](https://mymerci.kr/pages/nclex_q.php?qn_id=362756&lang=zh-tw)
- [A 28-year-old client with type 1 diabetes receives regular insulin 6 units and NPH insulin…](https://mymerci.kr/pages/nclex_q.php?qn_id=362792&lang=zh-tw)
- [A client receives IV vancomycin 1 g every 12 hours for MRSA bacteremia. Before the next do…](https://mymerci.kr/pages/nclex_q.php?qn_id=362833&lang=zh-tw)
- [A client with bipolar disorder has been taking lithium carbonate 600 mg orally three times…](https://mymerci.kr/pages/nclex_q.php?qn_id=362894&lang=zh-tw)
- [A nurse is monitoring a client receiving a continuous IV heparin infusion for pulmonary em…](https://mymerci.kr/pages/nclex_q.php?qn_id=363988&lang=zh-tw)
- [A nurse is preparing to initiate a weight-based continuous IV unfractionated heparin infus…](https://mymerci.kr/pages/nclex_q.php?qn_id=364107&lang=zh-tw)
- [A nurse is providing discharge teaching to a 65-year-old client newly prescribed warfarin …](https://mymerci.kr/pages/nclex_q.php?qn_id=364872&lang=zh-tw)

## 以其他語言閱讀

- [en](https://mymerci.kr/pages/nclex_q.php?qn_id=522059&lang=en)
- [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=522059&lang=ko)
- [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=522059&lang=ja)
- [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=522059&lang=zh-tw)
- [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=522059&lang=vi)

---

More free questions: [NCLEX-RN 題庫](https://mymerci.kr/pages/nclex_bank.php?lang=zh-tw)

_僅供學習參考。實際臨床請遵循最新指引與所屬機構規範。_