一位78歲患有慢性鬱血性心衰竭的男性，數年來皆持續服用處方的口服毛地黃 (Digoxin)。在歷經了三天的急性腸胃炎與腹瀉後，他帶著嚴重脫水來到心臟科門診。他向護理師抱怨：「我完全沒有胃口，覺得非常想吐，而且最詭異的是，我看見房間裡的燈光周圍有奇怪的黃綠色光暈。」護理師測量其橈動脈脈搏，發現跳動強而有力但極端緩慢，僅 48 次/分。護理師應明確懷疑是何種狀況？
A 78-year-old male with chronic congestive heart failure has been taking prescribed oral Digoxin (Lanoxin) for years. He visits the cardiology clinic severely dehydrated following a three-day bout of acute gastroenteritis and diarrhea. He complains to the nurse, "I've had zero appetite, I feel terribly nauseous, and bizarrely, I'm seeing strange yellow-green halos surrounding the lights in the room." The nurse checks his radial pulse and finds it bounding but extremely slow at 48 beats per minute. What condition should the nurse definitively suspect?
- AOphthalmic complications originating from a rapid worsening of age-related macular degeneration.源自於年齡相關黃斑部病變迅速惡化所引起的眼科併發症。
- BIschemic stroke in the occipital lobe presenting initially with visual disturbances and vomiting.枕葉缺血性中風，最初表現為視覺障礙和嘔吐。
- CSevere, life-threatening Digoxin toxicity triggered exponentially by likely hypokalemia from his diarrhea.✓ 正解由腹瀉可能引起的低血鉀所觸發的嚴重、危及生命的毛地黃中毒。
- DA normal, expected therapeutic effect of long-term Digoxin accumulation prioritizing cardiac resting.長期累積毛地黃以優先讓心臟休息的正常預期治療效果。
本題測驗高警訊藥物：毛地黃（Digoxin）的毒性監測。Digoxin 是一種治療心衰竭與心房顫動的強心劑，其治療指數狹窄。當病患發生嘔吐、使用利尿劑或嚴重腹瀉（Diarrhea）脫水時，極易流失鉀離子而誘發「低血鉀 (Hypokalemia)」。低血鉀會讓心臟對 Digoxin 極端敏感，使得正常劑量瞬間變為劇毒。Digoxin 中毒（Toxicity）呈現經典的三重奏徵象：1. 腸胃道症狀：這是最早期的警告（極度厭食 Anorexia、噁心嘔吐）。2. 心血管抑制：嚴重的心跳過緩（Bradycardia，心跳大於60才能給藥，此例已掉至致命的 48）。3. 視覺神經干擾：病患會反映出現視力模糊、色彩失真，特別是看到著名的「黃綠色光暈（Yellow-green halos）」。因此，護理師應立即將其視為這項藥物的特異性中毒（選項C正確）。選項A（黃斑部病變）與選項B（枕葉中風）的猜測忽視了心跳暴跌與腸胃前兆的整體藥理學聯繫。選項D（正常治療反應）是極度危險的誤判，心跳48次/分且伴隨中毒光暈絕非正常。
This question tests monitoring of the high-alert medication digoxin. Digoxin is a cardiotonic drug used to treat heart failure and atrial fibrillation, and it has a narrow therapeutic index. When a client experiences vomiting, uses diuretics, or has severe dehydration from diarrhea, they easily lose potassium and develop hypokalemia. Hypokalemia makes the heart extremely sensitive to digoxin, turning a normal dose into a potent toxin. Digoxin toxicity classically presents with a triad: (1) gastrointestinal symptoms, which are the earliest warning (severe anorexia, nausea, and vomiting); (2) cardiovascular suppression (severe bradycardia — the heart rate must be greater than 60 before administering the dose, and in this case it has dropped to a critical 48 bpm); and (3) visual neurologic disturbances (the client may report blurred vision, color distortion, and especially the well-known yellow-green halos around lights). Therefore, the nurse should immediately suspect specific toxicity of this medication (option C is correct). Options A (macular degeneration) and B (occipital lobe stroke) ignore the overall pharmacologic link between the dropped heart rate and gastrointestinal prodrome. Option D (normal therapeutic effect) is a dangerous misjudgment; a heart rate of 48 bpm with toxic halos is by no means a normal response.
「黃綠色光暈 + 厭食 + 心跳小於60」是各國護理國考關於 Digoxin (毛地黃) 絕對必背的鐵三角口訣。搭配低血鉀 (Hypokalemia) 誘發中毒的考點，也是台美通用的臨床基石。