— 藥理與非經腸給藥 · EASY · MCQ —
護理師準備給予心臟衰竭病人心臟藥物 digoxin，測量心尖脈搏為 54 下/分。護理師應優先採取哪項措施？
A nurse is administering a dose of digoxin to a patient with heart failure. Before administration, the nurse notes an apical pulse of 54 bpm. Which action is the priority?
- ARetake the pulse in one hour一小時後重新測量脈搏
- BAdminister the medication as ordered依指示給予藥物
- CWithhold the medication and notify the healthcare provider✓ 正解暫停給藥並通知醫療提供者
- DRequest an EKG to check for arrhythmias要求進行心電圖檢查以確認是否有心律不整
— Explanation · 中文詳解 —
Digoxin 具有正性肌力作用（增加心收縮力）與負性變時作用（減慢心跳）。由於其治療指數窄，極易發生中毒。臨床標準規定，成人給藥前必須測量心尖脈搏（Apical pulse），若小於 60 次/分，必須暫停給藥並通知醫師，以防止嚴重心搏過緩（bradycardia）及心律不整。這是用藥安全的核心評估。
Digoxin has a narrow therapeutic index and can cause bradycardia; therefore, the apical pulse must be assessed before administration. Since the client's pulse is 54 bpm, which is below the standard safety threshold of 60 bpm, the nurse should withhold the medication and notify the healthcare provider to prevent severe bradycardia.