# 一位 74 歲患有第 2 型糖尿病和第 3 期慢性腎臟病的病人，出現嗜睡、黏膜乾燥、血壓 92/54 mm Hg、血糖 824 mg/dL、有效滲透壓 326 mOsm/kg、血鉀 3.4 mmol/L，以及肌酸酐從 1.4 mg/dL 升至 2.3 mg/dL。請根據每個發現最直接支持的治療決策進行分類。 > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=522067&lang=zh-tw > language: zh-TW > subject: Adverse Effects/Contraindications/Interactions > category: PPT ## 題目 一位 74 歲患有第 2 型糖尿病和第 3 期慢性腎臟病的病人，出現嗜睡、黏膜乾燥、血壓 92/54 mm Hg、血糖 824 mg/dL、有效滲透壓 326 mOsm/kg、血鉀 3.4 mmol/L，以及肌酸酐從 1.4 mg/dL 升至 2.3 mg/dL。請根據每個發現最直接支持的治療決策進行分類。 | | 支持初始輸液補充 | 改變胰島素或血鉀安全性 | 需要受控的滲透壓校正 | | --- | --- | --- | --- | | 血壓 92/54 mm Hg 伴黏膜乾燥 | | | | | 血鉀為 3.4 mmol/L | | | | | 肌酸酐從 1.4 mg/dL 升至 2.3 mg/dL | | | | | 有效滲透壓為 326 mOsm/kg | | | | | 病人嗜睡且定向力障礙 | | | | ## 解析 低血壓和脫水支持謹慎的輸液補充；血鉀 3.4 mmol/L 和急性腎損傷改變了鉀和胰島素的安全性；滲透壓和認知需要受控的校正和頻繁的神經學再評估。 ## 深入解析 快速解答 將線索分類為灌注、電解質-胰島素安全性以及受控的滲透壓校正。 為何此選項正確 HHS 的決策是相互關聯的：輸液恢復灌注和腎臟葡萄糖清除，血鉀低於 3.5 mmol/L 會延遲胰島素給予，腎功能受損會縮小補充耐受範圍，而滲透壓加上認知則決定了校正速度的安全性。 簡單類比或心像 將 HHS 視為恢復濃縮循環系統：小心補充液體，保護血鉀，然後以受控的速度降低血糖和滲透壓。 記憶點 灌注、血鉀、滲透壓：根據每個線索改變的決策進行分類。 NCLEX 決策規則 當一個線索同時改變循環和藥物安全性時，它可能支持多個決策。 為何其他選項錯誤 單獨處理血糖值會忽略低血容量、血鉀轉移、腎損傷和神經學風險。References 12024 Consensus Report: Hyperglycemic Crises in Adults With DiabetesHHS diagnosis, cautious fluids, potassium and insulin safety, controlled osmolality correction, and resolution criteria ## 臨床情境 HHS 線索分類 將每個評估發現與其改變的特定輸液、血鉀、胰島素或校正速度決策聯繫起來。 ## 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=522067&lang=en) - [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=522067&lang=ko) - [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=522067&lang=ja) - [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=522067&lang=zh-tw) - [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=522067&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。_