病人預定服用 Digoxin 0.125 mg，護理師評估心尖脈搏為 52 bpm。護理師應採取何項優先行動？

核心概念：Digoxin（地高辛）是一種強心苷類藥物，用於治療心臟衰竭和心房顫動。其主要副作用之一是導致心跳減慢（Bradycardia）和心律不整。因此，給藥前必須嚴格監測病人的心率。 為何正確答案對：選項 C 指出「暫停給藥並通知醫師」。Digoxin 的標準給藥前評估（APICAL PULSE < 60 bpm for adults）是成人心率低於 60 次/分鐘時應暫停給藥。心率 52 bpm 明顯低於此閾值，繼續給藥可能導致嚴重心律失常，甚至心跳停止。 為何其他選項錯： A. 「與一杯水一起服用」是藥物的一般服用指示，但並非處理心率過慢的優先行動。 C. 「30 分鐘後複檢心跳」雖然是監測的一部分，但病人目前的心率已經低於安全標準，立即採取行動（暫停給藥並通知醫師）比等待更為重要和緊急。 D. 低血鉀（Hypokalemia）會增加 Digoxin 的毒性反應，因此監測鉀離子濃度是重要的，但這是在評估藥物安全性的背景下，而非直接處理當前心率過低的即刻行動。眼前的優先事項是防止因心率過慢而導致的血行動力學不穩定。 臨床思路（Assessment / Intervention / Evaluation / Safety）：此題的臨床決策遵循「評估-介入-評估」的原則，並以「病人安全」為最高考量。心率 52 bpm 是一個潛在的危險信號，直接關係到病人的循環穩定性。護理師的首要職責是識別風險並採取預防措施，即暫停給藥並向上級報告，讓醫師決定後續處理。

Core concept: Digoxin is a cardiac glycoside used to treat heart failure and atrial fibrillation. One of its principal adverse effects is bradycardia and dysrhythmias; therefore, the heart rate must be strictly monitored prior to administration. Why the correct answer is right: Option C states "hold the dose and notify the provider." The standard pre-administration assessment for digoxin is to hold the dose when the apical pulse is less than 60 bpm in adults. A heart rate of 52 bpm is clearly below this threshold; continuing administration could lead to severe dysrhythmias or even cardiac arrest. Why the other options are wrong: A. "Administer with a glass of water" is a general administration instruction and is not the priority action for managing bradycardia. C. "Recheck the pulse in 30 minutes" is part of monitoring, but the client's current rate is already below the safety threshold; taking immediate action (holding the dose and notifying the provider) is more important and urgent than waiting. D. Hypokalemia potentiates digoxin toxicity, so monitoring potassium is important; however, this concerns drug-safety assessment in general rather than the immediate management of the current low heart rate. The immediate priority is to prevent hemodynamic instability caused by bradycardia. Clinical reasoning (Assessment / Intervention / Evaluation / Safety): The clinical decision follows the "assess–intervene–evaluate" principle with patient safety as the highest priority. A heart rate of 52 bpm is a potential warning sign that directly affects circulatory stability. The nurse's primary responsibility is to recognize the risk and take preventive action—holding the dose and reporting upward so the provider can determine further management.

Digoxin 的給藥前評估標準（成人心率低於 60 bpm 需暫停並通知醫師）在美國和台灣的臨床實務中是完全一致的。藥物監測與副作用處理的原則相同。此題涉及的藥物安全標準在國際間並無顯著差異。