# 一位76歲女性個案有慢性心衰竭及心房顫動，每日口服digoxin 0.125毫克。在給予早晨劑量前，護理師應根據下列何項評估結果暫停給藥並通知醫師？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=374883&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一位76歲女性個案有慢性心衰竭及心房顫動，每日口服digoxin 0.125毫克。在給予早晨劑量前，護理師應根據下列何項評估結果暫停給藥並通知醫師？

## 選項

1. 兩側輕微足踝水腫,與前日無變化
2. 坐姿血壓128/76 mmHg
3. 足背動脈兩側2+,微血管再充填時間少於3秒
4. 聽診心尖脈搏整整1分鐘,每分鐘54次 **✔ 正確答案**

**正確答案: 4**

## 解析

為何心尖脈54下需暫停給藥
Digoxin會減緩房室傳導；每次給藥前護理師需測量心尖脈一整分鐘，若速率低於機構定義的閾值（成人通常

## 深入解析

步驟1 — 投藥前評估
每劑digoxin前以心尖脈搏聽診1分鐘為標準。心房顫動時橈動脈觸診易漏掉pulse deficit。成人:

## 臨床情境

臨床情境
病人與成年女兒同住於家中。早晨例行:餐間搭配口服藥。護理師為居家照護RN,每日進行藥物投予檢查。

## 重要概念

- **Digoxin投藥前心尖脈搏規則** — 每劑digoxin前以心尖脈搏聽診1分鐘。成人:
- **HALOS toxicity首字** — Headache、Anorexia、Lethargy、Ocular變化(光暈黃綠色、視野模糊)、GI症狀(噁心、嘔吐、腹瀉)。早期辨識可預防致命性心律不整。
- **Digoxin治療範圍** — 血清0.5-2.0 ng/mL。治療指數狹窄。低K、低Mg、甲狀腺低下、高齡、腎功能不良、藥物交互作用(amiodarone、verapamil、quinidine)皆增加toxicity風險。

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