# 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?

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> language: en  
> subject: Medication Administration  
> category: PPT

## Question

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?

## Option

1. Hold the digoxin and notify the health care provider. **✔ Correct answer**
2. Give the digoxin and recheck the pulse in 30 minutes.
3. Administer the digoxin with food to decrease nausea.
4. Give the digoxin after checking only the radial pulse.

**Correct answer: 1**

## 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.

## In-depth explanation

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 scenario

Clinical Practice Guide
Open 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.

Caution
Do not give digoxin just because the dose is scheduled.

## Key concepts

- **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.

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