一位心衰竭病人正在服用毛地黃（Digoxin）。哪些發現顯示可能有中毒反應？（選所有適合的）
A client with heart failure is receiving digoxin. Which findings indicate potential toxicity? (Select all that apply.)
- AAnorexia and nausea✓ 正解食慾不振和噁心
- BVisual disturbances (yellow-green halos)✓ 正解視覺障礙（黃綠色暈圈）
- CBradycardia✓ 正解心動過緩
- DDiarrhea腹瀉
- EConfusion✓ 正解意識混亂
毛地黃（Digoxin）具有窄治療指數（Narrow therapeutic index），中毒風險高。其毒性機制源於抑制心肌細胞膜上的鈉鉀幫浦（Na+/K+-ATPase），導致電解質失衡與神經毒性。臨床護理需特別注意早期非特異性症狀，並定期監測血清濃度及心電圖（ECG）變化，特別是當病人伴隨低鉀血症時，中毒風險會大幅增加。
Digoxin has a narrow therapeutic index and a high risk of toxicity. Its toxicity mechanism arises from inhibition of the sodium-potassium pump (Na+/K+-ATPase) on the myocardial cell membrane, producing electrolyte imbalance and neurotoxicity. Clinically, nurses must pay particular attention to early nonspecific symptoms and monitor serum concentrations and ECG changes regularly, especially because the toxicity risk rises markedly when the client is also hypokalemic.
在美國，這類藥物常搭配低劑量使用，護理師在給藥前必測心尖脈（Apical pulse）滿 60 秒是標準流程；若低於 60 bpm，必須暫停給藥並通知醫師。