# Place the actions in order for a client taking digoxin who develops nausea, yellow-green vision, confusion, and a heart rate of 38/min.

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=396377&lang=en  
> language: en  
> subject: Medication Administration  
> category: PPT

## Question

Place the actions in order for a client taking digoxin who develops nausea, yellow-green vision, confusion, and a heart rate of 38/min.

Initiate continuous cardiac monitoring, secure IV access, and notify the responsible clinician or rapid-response team immediately

Assess airway, breathing, circulation, perfusion, vital signs, symptoms, and apical rhythm, and hold the due digoxin dose

Continue ECG, blood pressure, renal, and potassium surveillance during and after treatment and interpret post-antidote total digoxin levels cautiously

Obtain prescribed serum digoxin, potassium, magnesium, and kidney-function specimens before antidote administration when this will not delay emergency treatment

Provide prescribed supportive treatment and prepare or administer digoxin immune Fab promptly if toxicity is life-threatening or potentially life-threatening

## 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.

## In-depth explanation

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

## Clinical scenario

Suspected severe digoxin toxicity
The 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.

## Key concepts

- **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.

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