An older adult with heart failure is scheduled to receive digoxin. The apical pulse is 54/min and irregular, and the client reports nausea and seeing yellow halos. Which action should the nurse take?
1Give the digoxin and recheck the pulse in 30 minutes.
2Hold the digoxin and notify the health care provider.✓ Correct answer
3Administer the digoxin with food to decrease nausea.
4Give the digoxin after checking only the radial pulse.
Explanation
An apical pulse below 60/min, irregular rhythm, nausea, and yellow halos suggest possible digoxin toxicity or unsafe administration. The nurse should hold the medication and notify the provider. Giving the dose or relying only on a radial pulse could worsen bradycardia and toxicity.
Clinical Judgment Combine medication parameters with toxicity cues before administering high-risk cardiac medication.
Memory Tip Digoxin: apical pulse 1 full minute, hold for low pulse, watch halos and nausea.
KR vs US NCLEX often tests nursing responsibility to hold unsafe medications and notify the provider.
Clinical Practice GuideOpen RN pharmacology guidance notes that apical pulse should be assessed for a full minute before digoxin and toxicity signs include bradycardia, nausea, visual halos, and arrhythmias.
CautionDo not give digoxin just because the dose is scheduled.
Digoxin — A cardiac glycoside used for selected heart failure or atrial fibrillation clients; toxicity can cause bradycardia, nausea, halos, and dysrhythmias.
Apical Pulse — Heart rate heard at the cardiac apex and counted for a full minute before giving medications such as digoxin.
Bradycardia — A heart rate below expected range, often less than 60/min in adults, requiring assessment before rate-slowing medication.