護理師準備對心衰竭病人給予毛地黃（Digoxin）。給藥前測量心尖脈搏為 52 次/分，護理師應優先採取何種行動？
A nurse is administering a dose of digoxin to a patient with heart failure. Before administration, the nurse notes the apical pulse is 52 bpm. What is the priority nursing action?
- AAdminister the medication and document the pulse rate給藥並記錄脈搏速率
- BRetake the pulse in 30 minutes to see if it improves30 分鐘後重測脈搏以觀察是否改善
- CAsk the patient to walk around to increase the heart rate要求病人走動以增加心率
- DWithhold the dose and notify the healthcare provider✓ 正解暫停給藥並通知醫療提供者
Digoxin 具有負性心律作用（Negative chronotropic effect），能降低心跳速率。成人心率低於 60 次/分時，給藥會導致嚴重心跳過慢，甚至誘發危及生命的心律不整。這是高警訊藥物（High-alert medication）護理的關鍵安全步驟：評估心尖脈搏，若異常則暫停給藥並聯繫醫師，絕不能盲目給藥。
Digoxin has a negative chronotropic effect, slowing the heart rate. When the adult heart rate is below 60 beats per minute, administration can lead to severe bradycardia and even life-threatening dysrhythmias. This is a key safety step in the nursing care of high-alert medications: assess the apical pulse, and if it is abnormal, withhold the dose and contact the provider; the medication must never be given blindly.
在美國臨床實務中，對於給藥前心率的監測非常嚴格，護理師擁有隨時暫停給藥的權限（Scope of practice），並需詳細記錄於護理紀錄中，這體現了護理師作為病人安全守門人的角色。