護理師準備為一位心臟衰竭病人施予預定劑量的地高辛（Digoxin）。在給藥前，護理師應優先評估哪項檢查結果或徵象？
A nurse is preparing to administer a scheduled dose of digoxin to a client with heart failure. Which assessment finding should the nurse prioritize before administration?
- AApical heart rate of 52 beats per minute✓ 正解心尖脈率 52 次/分
- BBlood pressure of 110/70 mmHg血壓 110/70 mmHg
- CRespiratory rate of 18 breaths per minute呼吸頻率 18 次/分
- DSerum potassium level of 4.8 mEq/L血清鉀濃度 4.8 mEq/L
地高辛是一種強心苷類藥物，主要透過抑制鈉鉀幫浦來增強心肌收縮力（正性肌力），但同時會減慢房室傳導並降低心率（負性頻律）。核心安全原則是在給藥前必須評估心尖脈（Apical pulse）整整一分鐘。若成人心率低於 60 次/分，應暫緩給藥並通知醫師，因為心搏過緩可能是藥物濃度過高或中毒的早期跡象。地高辛的治療窗口非常窄（0.5-2.0 ng/mL），護理師必須在每次給藥前確認心率是否在安全範圍內，以預防嚴重的毒性反應或心律不整。臨床思路應鎖定藥物對心臟傳導系統的直接影響，將生命徵象監測放在首位。
Digoxin is a cardiac glycoside that primarily inhibits the sodium-potassium pump to increase myocardial contractility (positive inotropy) while slowing AV conduction and reducing heart rate (negative chronotropy). The core safety principle is to assess the apical pulse for a full minute before administration. If an adult's heart rate is below 60 beats per minute, the medication should be held and the provider notified, because bradycardia may be an early sign of elevated drug levels or toxicity. The therapeutic window for digoxin is very narrow (0.5-2.0 ng/mL), and the nurse must verify that the heart rate is within the safe range before each dose to prevent serious toxicity or arrhythmia. Clinical reasoning should focus on the drug's direct effect on the cardiac conduction system, placing vital sign monitoring foremost.
在美國護理實務中，護理師有權根據標準 Protocol（如 HR < 60）直接暫緩給藥並於之後補記，自主性較高；台灣醫院多數規定需先口頭報告醫師，由醫師裁示是否停藥或調整劑量，並在電子藥囑系統中標註原因。