# A 76-year-old female with chronic heart failure and atrial fibrillation receives digoxin 0.125 mg orally daily. Before administering the morning dose, which assessment finding requires the nurse to HOLD the dose and notify the provider?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=374883&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A 76-year-old female with chronic heart failure and atrial fibrillation receives digoxin 0.125 mg orally daily. Before administering the morning dose, which assessment finding requires the nurse to HOLD the dose and notify the provider?

## Option

1. Mild bilateral ankle edema unchanged from the previous day
2. Blood pressure 128 over 76 mmHg in the seated position
3. Pedal pulses 2+ bilaterally with capillary refill less than 3 seconds
4. Apical pulse of 54 beats per minute auscultated for one full minute **✔ Correct answer**

**Correct answer: 4**

## Explanation

Why apical 54 holds the dose
Digoxin slows AV conduction; before each dose the nurse measures the apical pulse for one full minute and holds the dose if the rate is below the institution-defined threshold (commonly

## In-depth explanation

Step 1 — Pre-dose assessment
Apical pulse for ONE FULL MINUTE is the assessment standard before each digoxin dose. Radial palpation can miss pulse deficits in atrial fibrillation. Adult threshold: hold if HR

## Clinical scenario

Clinical scenario
The 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.

## Key concepts

- **Digoxin pre-dose apical pulse rule** — Auscultate apical pulse for one full minute before each digoxin dose. Adult: hold if
- **HALOS toxicity acronym** — Headache, Anorexia, Lethargy, Ocular changes (yellow-green halos around lights, blurred vision), GI Symptoms (nausea, vomiting, diarrhea). Recognize early to prevent life-threatening arrhythmias.
- **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).

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