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?

• 1 Administer the dose as a deep IM injection in the ventrogluteal site using a large-gauge (21 gauge) 1.5 to 2 inch needle and Z-track technique; never give IV (associated with cardiopulmonary arrest); split very high doses between two sites; have the client remain in the clinic for at least 30 minutes after the injection to monitor for anaphylaxis with epinephrine readily available. ✓ Correct answer
• 2 Dilute the penicillin G benzathine in 10 mL of lidocaine and administer via slow IV push over 3 to 5 minutes, as this provides rapid systemic action and minimizes discomfort associated with IM injections; monitor for immediate therapeutic response; no need for subsequent observation since the medication is fully absorbed intravenously; this method is preferred for clients with phobia of needles to avoid multiple injections.
• 3 Administer the dose as a subcutaneous injection in the abdomen using a 25-gauge 5/8-inch needle at a 45-degree angle, pinch the skin, and aspirate before injecting; this route reduces pain and ensures consistent absorption; no intramuscular injection is needed because the medication is effective subcutaneously; no post-injection monitoring is required beyond a brief check for local reaction.
• 4 Administer the dose as a deep IM injection in the dorsogluteal site using a 22-gauge 1-inch needle without Z-track technique; do not split the dose, regardless of volume; inform the client that monitoring after the injection is unnecessary, and they may leave immediately; no epinephrine preparation is required since anaphylaxis is a rare occurrence with penicillin.

For study reference only. Always follow current clinical guidelines and your institution’s protocols.