護理師準備對心衰竭病人給予地高辛（Digoxin）。若出現哪些臨床發現應暫停給藥？（選所有適合的）
The nurse is administering a dose of digoxin to a patient with heart failure. Which clinical finding would warrant withholding the medication? (Select all that apply.)
- AApical pulse of 52 beats per minute✓ 正解心尖脈搏 52 次/分鐘
- BSerum potassium level of 3.2 mEq/L✓ 正解血清鉀濃度 3.2 mEq/L
- CClient reports seeing yellow halos around lights✓ 正解病人主訴看到燈光周圍有黃色光暈
- DBlood pressure of 130/80 mmHg血壓 130/80 mmHg
- ESerum digoxin level of 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，治療指數狹窄，極易產生毒性。護理師給藥前必須評估心率、電解質狀態及中毒徵象。當心率過慢（成人 <60 bpm）時，給藥會加重房室傳導阻滯；低血鉀（Hypokalemia）會增強地高辛與心肌細胞鈉鉀幫浦的結合，導致毒性增加。視覺障礙（如黃視症）是地高辛中毒的典型神經毒性表現。血壓與血藥濃度在正常範圍內，無需停藥。臨床思路應優先評估心臟傳導穩定性及潛在藥物相互作用。
Digoxin exerts positive inotropic and negative chronotropic effects, has a narrow therapeutic index, and is highly prone to toxicity. Before administration, the nurse must assess heart rate, electrolyte status, and signs of toxicity. When the heart rate is too low (adults <60 bpm), administration would worsen AV conduction block; hypokalemia enhances the binding of digoxin to the myocardial sodium-potassium pump, increasing toxicity. Visual disturbances (such as yellow halos) are a classic neurotoxic manifestation of digoxin toxicity. Blood pressure and serum drug level within normal ranges do not warrant withholding the dose. Clinical reasoning should prioritize cardiac conduction stability and potential drug interactions.
在美國臨床執業中，對於地高辛給藥前心率的監測標準非常嚴格（通常 <60 bpm 即不給藥），且護理師具備高度自主權在評估後決定是否暫停給藥並報告，這與台灣臨床常需依賴醫師指示有所不同。