Before giving a scheduled dose of digoxin, the nurse obtains an apical pulse of 54/min in an adult who reports new nausea and blurred yellow vision. Which action should the nurse take?
1Hold the dose, assess for toxicity, and notify the prescriber for further instructions.✓ Correct answer
2Give the dose with food, document the pulse, and reassess the client in 1 hour.
3Administer the dose with an antacid, then repeat the apical pulse after ambulation.
4Give the dose as scheduled and arrange a routine eye examination for the next visit.
Explanation
Bradycardia accompanied by new gastrointestinal and visual symptoms is concerning for digoxin toxicity. The nurse should hold the scheduled dose, assess the client, and notify the prescriber; evaluation can include rhythm, serum digoxin concentration, electrolytes, and renal function. Administering the dose or treating the symptoms as routine can worsen toxicity or delay needed assessment.
Clinical reasoning Digoxin toxicity can present with nausea, visual disturbances, bradycardia, and other arrhythmias. The combination of symptoms and a slow apical pulse requires the dose to be held and the prescriber notified.
Decision rule Check an apical pulse for a full minute before digoxin and follow the prescribed hold parameters; symptomatic bradycardia requires prompt escalation.
Clinical scenarioThe 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.
Digoxin toxicity — A toxic digoxin effect that can cause gastrointestinal symptoms, visual disturbances, bradycardia, and other arrhythmias.
Apical pulse assessment — A full-minute apical pulse is obtained before digoxin; the nurse follows the prescribed hold parameters and escalates symptomatic bradycardia.
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).