# A nurse is caring for a client prescribed Digoxin. Which nursing action is most appropriate regarding assessing apical pulse and withholding the dose if signs of toxicity occur?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391746&lang=ja  
> language: ja  
> subject: Medication Administration  
> category: PPT

## 問題

A nurse is caring for a client prescribed Digoxin. Which nursing action is most appropriate regarding assessing apical pulse and withholding the dose if signs of toxicity occur?

## 選択肢

1. 「Valproateは抗けいれん薬の中で最も催奇形リスクが高く、神経管欠損や発達遅延を起こします。神経内科と産科への緊急相談が不可欠です。」 **✔ 正解**
2. "Valproateは既知の催奇形性薬剤です。直ちに中止する必要があり、fluoxetine 20 mgを毎日開始することが妊娠中の気分安定化のための安全な代替手段です。"
3. 妊娠初期のValproate曝露は自然に消失する軽微な奇形と関連しています。神経管欠損の臨界期は20週から始まります。
4. 妊娠中の双極性障害再発リスクはvalproateの催奇形性リスクを上回ります。現在の用量を継続し、月1回薬物濃度をモニターしてください。

**正解: 1**

## 解説

When administering Digoxin, key nursing considerations include monitoring patient status, checking critical laboratory values, and providing appropriate safety education. Unsafe practices such as stopping medications abruptly or doubling missed doses are incorrect.

## 詳細解説

覚え方 Valproate = 胎児に最も毒性が強い抗けいれん薬。代替が全くなく確実な避妊がある場合以外、妊娠可能年齢の女性では避ける。避けられない曝露では葉酸4 mg/日以上。

## 臨床シナリオ

シナリオ 28歳女性。双極性障害でvalproate 1000 mg/dayを内服中。妊娠検査陽性で妊娠6週。現在の治療で安定している。

## 重要概念

- **神経管欠損** — 神経管閉鎖不全（脊椎披裂、無脳症）。4-5週までに起こり、valproateは最も強い催奇形薬の一つ。
- **催奇形リスク** — 胎内曝露で胎児奇形が起こる確率。valproateは全薬剤の中でも高い部類。
- **妊娠中の抗けいれん薬** — 比較的安全な代替薬はlamotrigineとlevetiracetam。phenytoinとcarbamazepineは中等度、valproateとtopiramateは高リスク。

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