心衰竭病人正在使用地高辛（Digoxin）。哪些發現顯示可能有毒性反應？（選所有適合的）
A client with heart failure is receiving digoxin. Which findings should the nurse identify as potential toxicity? (Select all that apply.)
- AAnorexia and nausea✓ 正解厭食與噁心
- BVisual disturbances such as blurred vision✓ 正解視覺障礙如視力模糊
- CBradycardia✓ 正解心搏過緩
- DIncreased appetite食慾增加
- EConfusion✓ 正解意識混亂
地高辛（Digoxin）具有窄治療指數（Narrow Therapeutic Index），極易發生毒性反應。其毒性機制涉及對胃腸道、視覺系統、心臟傳導系統及中樞神經的廣泛影響。護理師應特別留意病人的電解質狀況（尤其是低血鉀），因為低血鉀會顯著增加地高辛的敏感度與毒性風險。臨床評估時，優先執行心尖脈搏測量，若心跳過慢（小於60次/分）則應暫停給藥並通知醫師。
Digoxin has a narrow therapeutic index, and toxicity often presents with gastrointestinal symptoms like anorexia and nausea, visual disturbances such as blurred vision or halos, and cardiac effects including bradycardia. Central nervous system changes like confusion may also occur, particularly in the context of electrolyte imbalances such as hypokalemia.
在美國臨床實務中，對於地高辛血中濃度監測（Therapeutic range: 0.5-2.0 ng/mL）的依賴度極高，且護理師在給藥前必須親自測量心尖脈搏（Apical pulse）整整一分鐘，若低於60 bpm則必須Hold住藥物，這點與台灣臨床護理常規高度一致。