護理師準備給予心衰竭病人毛地黃（Digoxin），聽診心尖脈發現速率為 54 bpm。護理師應優先採取的行動為何？
A nurse is administering digoxin to a patient with heart failure. Before administration, the nurse notes the apical heart rate is 54 bpm. What is the priority nursing action?
- AAdminister the medication and document the rate給藥並記錄心率
- BWithhold the dose and notify the healthcare provider✓ 正解暫停給藥並通知醫療保健提供者
- CRetake the pulse in one hour一小時後重新測量脈搏
- DRequest an EKG before proceeding繼續前請求心電圖檢查
Digoxin 具有負性變時作用，成人心率低於 60 bpm 時應暫停給藥，以防嚴重心跳過緩。護理師應主動評估並保護病人安全，暫停給藥後通知開立處方的醫師評估是否調整劑量或更換藥物，確保醫療決策的即時性。
Digoxin has a negative chronotropic effect; in adults, if the heart rate is less than 60 bpm, the dose should be withheld to prevent severe bradycardia. The nurse should proactively assess and protect the client's safety, withhold the dose, and then notify the prescribing provider to evaluate whether the dose should be adjusted or the medication changed, ensuring timely medical decision making.
台美臨床對於毛地黃給藥標準一致，但在電子病歷系統中，美國護理師可直接備註「held due to bradycardia」，台灣則常需配合醫囑系統修改執行紀錄。