A client taking digoxin reports nausea and yellow-green vision and has a new apical heart rate of 52/min. For each finding or action, select the best classification.
Matrix
Choose your responses, then check the answer.
Explanation
Nausea, color-vision change, and new bradycardia suggest digoxin toxicity. Hold the due dose according to prescribed parameters and notify the provider. Obtain ECG and ordered digoxin, potassium, magnesium, calcium, and renal studies; kidney impairment and electrolyte abnormalities increase toxicity risk.
Quick answer Connect nausea, yellow-green vision, and new bradycardia as a digoxin-toxicity pattern. Hold the due dose per parameters, notify the provider, and evaluate rhythm, renal function, electrolytes, and drug concentration.
Why this is correct Digoxin toxicity can produce gastrointestinal symptoms, visual changes, sinus bradycardia, and multiple dysrhythmias. Impaired renal clearance and low potassium or magnesium can increase susceptibility even when a concentration is not markedly elevated.
Easy analogy or mental picture Digoxin has a narrow safety lane. Slower kidney clearance or electrolyte imbalance can move the client toward toxicity without a dramatic dose change.
NCLEX decision rule Assess the apical rate and symptoms before the dose. For new bradycardia with toxicity cues, hold according to the order or facility parameters and notify the provider. Review ECG, appropriately timed drug concentration, renal function, and potassium, magnesium, and calcium.
Why the other choices are wrong Giving the dose because nausea is common ignores a clustered toxicity pattern. Automatically giving potassium before checking the level can be dangerous, especially when acute overdose or renal impairment is possible.
Source
1DailyMed: Digoxin Tablets Prescribing Information
22026 NCLEX-RN Test Plan
The nurse reviews the medication record, ECG, renal function, electrolytes, and the timing of any prescribed serum digoxin concentration. The next dose is due, and the provider is available for immediate evaluation of suspected toxicity.
Digoxin toxicity — Adverse digoxin effects that can involve the gastrointestinal, visual, neurologic, and cardiac conduction systems.
Apical heart rate — The heart rate auscultated at the cardiac apex, used with rhythm and symptoms when assessing digoxin safety.
Narrow therapeutic index — A small separation between an effective drug exposure and an exposure associated with toxicity.