護理師欲給予心衰竭病人 digoxin 0.25 mg 口服。出現下列何種臨床指標時應暫停給藥？
A nurse is administering digoxin 0.25 mg orally to a client with heart failure. Which clinical finding requires the nurse to withhold the medication?
- ARespiratory rate 18 breaths/minute呼吸速率 18 次/分
- BSerum potassium 4.2 mEq/L血清鉀 4.2 mEq/L
- CApical pulse 54 beats/minute✓ 正解心尖脈搏 54 次/分
- DBlood pressure 110/70 mmHg血壓 110/70 mmHg
Digoxin 具有強心與負性頻率（Negative chronotropic）作用，能減慢房室結（AV node）傳導。若病人出現心搏過緩（通常指成人 < 60 bpm），給藥可能導致嚴重心律不整或 Digoxin 毒性。護理師給藥前必須執行「心尖脈（Apical pulse）」聽診一分鐘。若脈搏過慢，應暫停給藥並通知醫師，這是護理師在藥物安全管理上的基本職責。
The nurse should withhold digoxin if the apical pulse is less than 60 beats per minute in an adult, as the drug slows conduction through the AV node and can exacerbate bradycardia. Administering digoxin to a client with a low heart rate increases the risk of toxicity and severe arrhythmias. Normal respiratory rate, potassium level, and blood pressure do not contraindicate administration.
在美國臨床實務，護理師對 Digoxin 給藥前的評估非常嚴謹，若電子病歷（EMR）設定了自動警示，護理師必須嚴格遵守，且必須記錄心跳數值。台灣臨床亦有類似規範，但美國更強調護理師的自主判斷與記錄完整性。