護理師準備給予病人地高辛（digoxin）。下列哪些發現需要暫停給藥並聯繫醫師？（選所有適合的）
A nurse is preparing to administer digoxin. Which client finding requires holding the dose and notifying the provider? (Select all that apply.)
- AApical pulse 52 beats per minute✓ 正解心尖脈搏 52 次/分
- BSerum potassium 3.2 mEq/L✓ 正解血清鉀離子 3.2 mEq/L
- CVisual disturbances such as blurred vision✓ 正解視力障礙，例如視力模糊
- DBlood pressure 110/70 mmHg血壓 110/70 mmHg
- ESerum digoxin level 1.2 ng/mL血清地高辛濃度 1.2 ng/mL
地高辛（Digoxin）具有正性肌力與負性頻率作用，治療指數極窄，易發生洋地黃中毒（Digitalis toxicity）。護理評估重點在於偵測中毒徵兆與加重因子。心跳過慢（小於 60 bpm）會抑制傳導系統，低血鉀則會增加心肌細胞對地高辛的敏感度，兩者皆會顯著提高中毒風險。此外，神經毒性（如視力模糊、黃綠色視覺異常）是經典的臨床警訊。護理師給藥前必須檢查心跳速率、電解質數值及病人主訴，若有異常應立即暫停給藥並回報醫師。
Digoxin has positive inotropic and negative chronotropic effects, with a very narrow therapeutic index that predisposes to digitalis toxicity. The focus of nursing assessment is on detecting toxicity and its contributing factors. A heart rate below 60 bpm suppresses the conduction system, and hypokalemia increases myocardial sensitivity to digoxin; both significantly increase the risk of toxicity. Neurotoxic effects (such as blurred vision and yellow-green visual disturbances) are classic clinical warning signs. Before administering digoxin, the nurse must check the heart rate, electrolyte values, and the client's complaints; if any abnormalities are present, the dose should be held and the physician notified.
台灣與美國在給藥常規上皆要求給藥前監測心跳，但美國臨床護理實務對於地高辛的給藥流程非常嚴格，若心跳低於 60 下，護理師有明確的權限（Scope of Practice）暫停給藥並通知醫師，無需醫師開立額外醫囑。