護理師準備給予病人地高辛（Digoxin），若發現何種情形需暫停給藥？
A nurse is preparing to administer digoxin to a client. Which findings would require the nurse to hold the medication?
- APotassium level of 4.2 mEq/L血鉀濃度 4.2 mEq/L
- BClient reports feeling slightly tired個案主訴感覺稍顯疲倦
- CApical pulse rate of 54 bpm✓ 正解心尖脈搏速率 54 bpm
- DBlood pressure of 130/80 mmHg血壓 130/80 mmHg
核心概念：地高辛（Digoxin）的用藥監測與禁忌。 為何正確答案對： C. 心搏速率 54 bpm（Apical pulse rate of 54 bpm）是需要暫停給予 Digoxin 的情況。Digoxin 是一種強心苷類藥物，具有負性變時作用（negative chronotropic effect），會減慢心率。一般臨床指引建議，若成人心搏速率低於 60 次/分鐘，應暫停給藥並聯繫醫師，以防引發心跳過慢（bradycardia）甚至心臟停止。 為何其他選項錯： D. 血壓 130/80 mmHg（Blood pressure of 130/80 mmHg）屬於正常或輕度偏高範圍，本身並非 Digoixn 的禁忌。 A. 血鉀水平 4.2 mEq/L（Potassium level of 4.2 mEq/L）處於正常範圍（約 3.5-5.0 mEq/L），此時給予 Digoxin 是安全的。若血鉀偏低（Hypokalemia），則會增加 Digoxin 的毒性與副作用風險。 B. 病人主訴「感覺有點累」（Client reports feeling slightly tired）可能原因眾多，雖然 Digoxin 的副作用之一是疲勞，但單憑此主訴，且心率正常（假設，未提供），不構成立即停藥的絕對理由。若心率偏慢（選項 C），疲勞感則更需警惕。 臨床思路/安全優先：藥物安全是護理的核心。Digoxin 雖然能增強心肌收縮力，但其治療窗狹窄，劑量稍有不慎即可能引發中毒。心率監測是給藥前最基本且重要的評估，直接關係到病人的血液動力學穩定與生命安全。
Core concept: medication monitoring and contraindications for digoxin. Why the correct answer is right: A. An apical pulse rate of 54 bpm is a situation in which digoxin should be withheld. Digoxin is a cardiac glycoside with a negative chronotropic effect, slowing the heart rate. Clinical guidelines generally recommend that in adults, if the apical pulse is below 60 beats/min, the dose should be withheld and the physician contacted to prevent bradycardia or cardiac arrest. Why the other options are wrong: B. A blood pressure of 130/80 mmHg falls within the normal-to-mildly-elevated range and is not in itself a contraindication to digoxin. C. A potassium level of 4.2 mEq/L is within the normal range (approximately 3.5-5.0 mEq/L); administering digoxin under these conditions is safe. Low serum potassium (hypokalemia) increases the risk of digoxin toxicity and side effects. D. The client reporting feeling slightly tired may have many causes. Although fatigue is one of digoxin's side effects, this complaint alone (with a presumed normal heart rate) does not constitute an absolute reason to withhold the drug. If the heart rate were also low (option C), fatigue would deserve heightened concern. Clinical reasoning/safety priority: Medication safety is central to nursing. Although digoxin enhances cardiac contractility, its therapeutic window is narrow and slight overdosing can cause toxicity. Heart rate monitoring is the most basic and important pre-administration assessment, directly affecting hemodynamic stability and patient safety.