# 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=zh-tw  
> language: zh-TW  
> subject: Medication Administration  
> category: PPT

## 題目

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?

## 選項

1. 「Valproate在所有抗癲癇藥中致畸胎風險最高，會造成神經管缺損與發展遲緩。必須立即會診神經科與產科。」 **✔ 正確答案**
2. Valproate 是已知的致畸胎藥物；需要立即停用，並開始每天服用 fluoxetine 20 mg 作為懷孕期間情緒穩定的安全替代方案。
3. 在第一孕期暴露 Valproate 與輕微畸形有關，這些畸形會自行消退；神經管缺陷的關鍵期始於 20 週。
4. 懷孕期間雙相情感障礙復發的風險大於 valproate 的致畸風險；繼續目前劑量，並每月監測藥物濃度。

**正確答案: 1**

## 解析

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.

## 深入解析

記憶提示 Valproate = 對胎兒最具毒性的抗癲癇藥。除非完全沒有替代方案且有可靠避孕，否則育齡女性應避免。若無法避免暴露，葉酸至少4 mg/day。

## 臨床情境

情境 28歲女性因雙相情緒障礙服用valproate 1000 mg/day。妊娠試驗陽性，懷孕6週。目前在此治療下穩定。

## 重要概念

- **神經管缺損** — 神經管閉合失敗，如脊柱裂、無腦症；發生於第4-5週，valproate是最強致畸胎藥之一。
- **致畸胎風險** — 胎內暴露導致胎兒畸形的機率；valproate屬於所有藥物中最高風險之一。
- **孕期抗癲癇藥** — 較安全替代藥包括lamotrigine與levetiracetam；phenytoin與carbamazepine為中等風險；valproate與topiramate風險最高。

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