# 一位有症狀性低血鈉的病人開始服用tolvaptan。護理師應質疑哪項醫囑？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522892&lang=zh-tw  
> language: zh-TW  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## 題目

一位有症狀性低血鈉的病人開始服用tolvaptan。護理師應質疑哪項醫囑？

## 選項

1. 在醫院開始治療並頻繁監測血鈉。
2. 在初始校正期間，除非有其他緊急適應症改變計畫，否則應允許病人依口渴程度飲水。
3. 監測血鈉校正過快和神經學變化。
4. 在最初 24 小時內限制所有口服液體以加速血鈉校正。 **✔ 正確答案**

**正確答案: 4**

## 解析

Tolvaptan 必須在醫院開始或重新開始使用。在最初 24 小時內限制液體攝入可能會增加血鈉校正過快的風險，通常應避免。

## 深入解析

快速解答
透過監測血鈉並避免早期強制性液體限制來預防過度校正。

為何這是正確的
快速校正可能導致滲透性脫髓鞘，因此期望的終點是受控而非最大程度的排水。

簡單類比或心像
建立藥物安全鏈：識別新的徵兆，將其與藥物作用機制或標示限制連結，停止可預防的暴露，穩定病人，並驗證可測量的反應。

記憶點
藥物、緊急徵兆、保護性措施和再評估終點。

NCLEX 決策規則
選擇能預防最直接藥物相關傷害的措施，同時保留指示治療和必要的監測。

為何其他選項是錯誤的
繼續可疑暴露、將標示的危險徵兆正常化、替代未經授權的劑量或延遲升級的選項會使病人處於危險之中。References
1DailyMed: SAMSCA (tolvaptan)Hospital initiation and prevention of overly rapid sodium correction

## 臨床情境

藥物安全審查
核實適應症、當前評估、劑量和途徑、器官功能、交互作用、緊急毒性徵兆、授權行動和可測量的後續追蹤。

## 相同主題題目

- [A nurse is reviewing the morning lab results for an adult client receiving warfarin for at…](https://mymerci.kr/pages/nclex_q.php?qn_id=360515&lang=zh-tw)
- [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)
- [An 80-year-old male with heart failure is prescribed digoxin 0.125 mg daily. During mornin…](https://mymerci.kr/pages/nclex_q.php?qn_id=372686&lang=zh-tw)
- [A 38-year-old female with rheumatoid arthritis is being discharged with a new prescription…](https://mymerci.kr/pages/nclex_q.php?qn_id=372687&lang=zh-tw)

## 以其他語言閱讀

- [en](https://mymerci.kr/pages/nclex_q.php?qn_id=522892&lang=en)
- [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=522892&lang=ko)
- [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=522892&lang=ja)
- [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=522892&lang=zh-tw)
- [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=522892&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。_