A 76-year-old female with chronic heart failure and atrial f… | MyMerci
Medical EmergenciesPA
Question
A 76-year-old female with chronic heart failure and atrial fibrillation receives digoxin 0.125 mg orally daily. Before administering the morning dose, which assessment finding requires the nurse to HOLD the dose and notify the provider?
1Mild bilateral ankle edema unchanged from the previous day
2Blood pressure 128 over 76 mmHg in the seated position
3Pedal pulses 2+ bilaterally with capillary refill less than 3 seconds
4Apical pulse of 54 beats per minute auscultated for one full minute✓ Correct answer
Explanation
Why apical 54 holds the dose Digoxin slows AV conduction; before each dose the nurse measures the apical pulse for one full minute and holds the dose if the rate is below the institution-defined threshold (commonly
In-depth explanation
Step 1 — Pre-dose assessment Apical pulse for ONE FULL MINUTE is the assessment standard before each digoxin dose. Radial palpation can miss pulse deficits in atrial fibrillation. Adult threshold: hold if HR
Clinical scenario
Clinical scenario The client lives at home with her adult daughter. Morning routine: oral medications with breakfast. The nurse is the visiting home-health RN performing the daily medication administration check.
Key concepts
Digoxin pre-dose apical pulse rule — Auscultate apical pulse for one full minute before each digoxin dose. Adult: hold if
HALOS toxicity acronym — Headache, Anorexia, Lethargy, Ocular changes (yellow-green halos around lights, blurred vision), GI Symptoms (nausea, vomiting, diarrhea). Recognize early to prevent life-threatening arrhythmias.
Digoxin therapeutic range — Serum 0.5-2.0 ng/mL. Narrow therapeutic index. Toxicity risk increases with hypokalemia, hypomagnesemia, hypothyroidism, advanced age, renal impairment, and drug interactions (amiodarone, verapamil, quinidine).