Place the actions in order for a client taking digoxin who develops nausea, yellow-green vision, confusion, and a heart rate of 38/min.
Ordered Response
Choose your responses, then check the answer.
Explanation
Assess severity and stop further digoxin exposure first, then place the client on continuous monitoring and escalate immediately. Obtain decision-relevant laboratory specimens before digoxin immune Fab when possible, but do not delay antidote treatment for a life-threatening presentation. Treat instability and electrolyte problems as prescribed and administer the antidote when indicated. After immune Fab, total digoxin immunoassays may be misleading, and potassium can fall rapidly, so continued ECG and laboratory surveillance is essential.
Correct sequence Assess and hold → monitor and escalate → draw pre-antidote labs if feasible → support and give immune Fab when indicated → monitor ECG and potassium closely.
Clinical judgment Severe bradycardia, advanced heart block, ventricular dysrhythmia, or dangerous hyperkalemia can make digoxin toxicity life-threatening. The antidote decision is clinical; a delayed or isolated serum level must not override instability.
NCLEX decision rule Hold the source, stabilize the client, obtain useful pre-antidote data without delaying rescue, then watch for potassium shifts after reversal.
References
1DailyMed: DIGIFAB Prescribing Information
2DailyMed: Digoxin Injection
Suspected severe digoxin toxicityThe client is awake but dizzy, the next digoxin dose is due now, and emergency prescriptions can be obtained immediately. Follow local emergency protocol and the current DIGIFAB prescribing information.
Digoxin Immune Fab — Antibody fragments that bind digoxin and are used for life-threatening or potentially life-threatening toxicity.
Xanthopsia — A yellow or yellow-green visual disturbance associated with digoxin toxicity.
Digitalis Immunoassay Interference — Misleading elevation of measured total digoxin after immune Fab binds circulating drug.