護理師準備協助數位病人辦理出院，哪些病人需要針對用藥安全進行進一步指導？（選所有適合的）
The nurse is preparing to discharge several clients. Which clients require further teaching regarding medication safety? (Select all that apply.)
- AA client taking Warfarin who states they will increase their consumption of green leafy vegetables✓ 正解服用 Warfarin 的病人表示將增加深綠色葉菜類的攝取量
- BA client taking Levothyroxine who states they take it with breakfast daily✓ 正解服用 Levothyroxine 的病人表示每天隨早餐服用
- CA client taking Digoxin who states they will hold the dose if their pulse is 72 bpm✓ 正解服用 Digoxin 的病人表示若脈搏為 72 bpm 將暫停給藥
- DA client taking Lisinopril who reports getting up slowly to avoid dizziness服用 Lisinopril 的病人表示會緩慢起身以避免頭暈
- EA client taking Metformin who plans to drink grapefruit juice to help with digestion✓ 正解服用 Metformin 的病人計劃飲用葡萄柚汁以幫助消化
出院用藥指導的目的在於防止藥物交互作用與降低副作用風險。Warfarin 與深綠色蔬菜（富含維生素 K）的攝取會影響凝血效果，飲食須穩定而非隨意增加；Levothyroxine 必須在空腹下服用，與早餐同時服用會影響吸收率；Digoxin 的停藥標準通常為心跳小於 60 bpm，72 bpm 屬於正常範圍，擅自停藥會導致心衰竭惡化；Metformin 與葡萄柚汁雖無直接致死性交互作用，但長期使用可能改變藥物代謝速度。唯一正確的是 Lisinopril 的病人，因其了解姿態性低血壓的風險，知道需緩慢起身。此題重點在於確認病人是否理解藥物作用機制與安全界限，任何對用藥邏輯的謬誤都可能導致嚴重的居家健康危害。
The purpose of discharge medication teaching is to prevent drug interactions and reduce adverse effect risk. Warfarin interacts with dark green vegetables (which are rich in vitamin K), so intake must be kept consistent rather than increased arbitrarily; levothyroxine must be taken on an empty stomach—taking it with breakfast will impair absorption; the criterion for holding digoxin is generally a heart rate below 60 bpm, while 72 bpm is within the normal range, so holding it on the client's own initiative would worsen heart failure; metformin and grapefruit juice do not have a directly lethal interaction, but long-term grapefruit consumption may alter drug metabolism. Only the lisinopril client is correct, because they understand the risk of orthostatic hypotension and know to rise slowly. This question emphasizes confirming that clients understand the mechanism and safety limits of their medications, since any error in medication reasoning can produce serious health hazards at home.
美國護理師在『用藥教育（Medication Reconciliation）』中擁有極大的教學責任，出院前必須逐一確認病人的居家藥物與新處方；台灣常由藥師進行出院藥物指導，護理師較常專注於傷口與生活事項，但在評鑑要求下，護理師也需執行基本的用藥安全性核對。