An 80-year-old male with heart failure is prescribed digoxin 0.125 mg daily. During morning assessment, he reports 2 days of nausea and vomiting and states he sees yellow-green halos around lights. His apical pulse is 46 bpm and regular. Which action should the nurse take first?

1 Administer IV atropine immediately to correct the bradycardia.
2 Increase the digoxin dose to improve cardiac output given the client's heart failure.
3 Hold the digoxin dose, notify the provider, and prepare to obtain a serum digoxin level. ✓ Correct answer
4 Administer the scheduled digoxin dose because 0.125 mg is a low therapeutic dose.

Explanation

The client presents with the classic triad of digoxin toxicity: bradycardia (HR 46), gastrointestinal symptoms (nausea and vomiting), and visual disturbances (yellow-green halos). The nurse must hold the dose and notify the provider. Serum digoxin level confirms toxicity. IV atropine may be used for symptomatic bradycardia, but the priority is holding the drug. Administering or increasing the dose with active toxicity signs would worsen the condition.

Next question on this topicA nurse is reviewing the morning lab results for an adult client receiving warfarin for at…

In-depth explanation

Clinical Judgment
Three simultaneous cues = digoxin toxicity: HR 46 (bradycardia) + nausea/vomiting (GI toxicity) + yellow-green halos (visual toxicity). All three together are pathognomonic. The narrow therapeutic index (0.5–0.9 ng/mL) makes elderly patients especially vulnerable.

Memory Tip
DIGOXIN TOXICITY = Brad-GI-Vision: Bradycardia + GI upset + Visual halos (yellow/green/blurred). Hold → Notify → Level.

KR vs US
In Korea, digoxin is commonly used in older adults with AF/HF. NCLEX emphasizes the narrow therapeutic index and toxicity recognition; hold and report, not self-adjustment.

Clinical scenario

Clinical Practice Guide
AHA/ACC HF Guidelines: digoxin therapeutic range 0.5–0.9 ng/mL for HF. Toxicity risk increases with hypokalemia, hypomagnesemia, renal impairment (common in elderly). Hold dose, obtain level, check electrolytes (K+, Mg2+), and prepare Digibind if severe toxicity.

Caution
NCLEX: "low dose" is a classic distractor — toxicity is about serum level and clinical signs, NOT dose size. An 80-year-old with decreased GFR accumulates digoxin faster at the same dose.

Key concepts

Digoxin Toxicity — Serum digoxin > 2.0 ng/mL (adult). Classic triad: bradycardia, GI symptoms (nausea/vomiting/anorexia), visual disturbances (yellow-green halos, blurred vision). Risk factors: hypokalemia, renal impairment, advanced age.
Digoxin in Heart Failure — Positive inotropic effect (increases contractility) + negative chronotropic effect (decreases HR). Therapeutic range in HF: 0.5–0.9 ng/mL. Renally excreted — dose adjustment required with renal impairment.
Digibind (digoxin antibody) — Antidote for severe digoxin toxicity. Binds digoxin and promotes renal excretion. Indications: life-threatening dysrhythmia, serum level > 10 ng/mL, severe hyperkalemia. Monitor potassium after administration.

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An 80-year-old male with heart failure is prescribed digoxin 0.125 mg daily. During morning assessment, he reports 2 days of nausea and vomiting and states he sees yellow-green halos around lights. His apical pulse is 46 bpm and regular. Which action should the nurse take first?

In-depth explanation

Clinical scenario

Key concepts

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