— 藥理與非經腸給藥 · EASY · MCQ —
護理師準備給予心衰竭病人毛地黃（Digoxin）。下列哪項臨床表現需要護理師暫停給藥？
A nurse is administering a dose of digoxin to a patient with heart failure. Which clinical finding requires the nurse to withhold the medication?
- AClient reports mild nausea病人主訴輕微噁心
- BApical pulse of 52 bpm✓ 正解心尖脈搏 52 次/分
- CSerum potassium level of 4.0 mEq/L血清鉀濃度 4.0 mEq/L
- DBlood pressure of 110/70 mmHg血壓 110/70 mmHg
— Explanation · 中文詳解 —
毛地黃具有負性變時作用，會減慢心跳。成人心跳低於 60 bpm 為暫停給藥的界線，以預防嚴重的心搏過緩及心律不整。低血鉀會增加毛地黃毒性，但 4.0 在正常範圍。噁心雖為毒性症狀之一，但應先評估心跳速率。
Digoxin has a negative chronotropic effect, slowing the heart rate; therefore, the dose must be withheld if the apical pulse is below 60 bpm in adults to prevent severe bradycardia. While nausea can be a sign of toxicity, the heart rate is the immediate physiological parameter to assess before administration. A serum potassium of 4.0 mEq/L is within the normal range and does not require holding the medication.
✦ 台美臨床差異
台美對毛地黃給藥前評估共識一致，皆要求測量完整一分鐘心尖脈。