— 藥理與非經腸給藥 · EASY · MCQ —
護理師準備給予心衰竭病人地高辛（Digoxin），聽診心尖脈為 58 次/分。護理師應採取的最優先行動為何？
A nurse is administering digoxin to a patient with heart failure. Before administration, the nurse notes the apical pulse is 58 bpm. What is the priority nursing action?
- AReassess the pulse in 30 minutes30 分鐘後重新評估脈搏
- BHold the medication and notify the provider✓ 正解暫停給藥並通知醫師
- CAdminister half the dose給予半劑量
- DAdminister the dose as ordered依醫囑給藥
— Explanation · 中文詳解 —
Digoxin 具負性變時作用，成人心尖脈若低於 60 bpm 應暫停給藥以預防毒性與嚴重心搏過緩。該病人脈搏低於標準，繼續給藥會加重風險。補救措施應由醫師評估是否調整劑量或檢查血清濃度，不可自行減量或等待。
Digoxin has a negative chronotropic effect; in adults, an apical pulse below 60 bpm requires holding the dose to prevent toxicity and severe bradycardia. A pulse of 58 bpm is below threshold, so continuing the dose increases risk. The provider must assess whether to adjust the dose or check serum levels; the nurse cannot independently reduce the dose or merely wait.
✦ 台美臨床差異
台美兩地對 Digoxin 給藥準則一致，護理師均需在給藥前監測並執行暫停給藥的決策權。