Which assessment should the nurse perform before administering digoxin?

Digoxin is a cardiac glycoside used for atrial fibrillation and heart failure. It slows heart rate (negative chronotropy) and increases contractility (positive inotropy). The nurse counts the apical heart rate for a FULL minute before administration. Hold and notify the provider if apical HR is below 60 bpm in adults (below 70 in children, below 90 in infants). Digoxin has a narrow therapeutic range (therapeutic level 0.5-2.0 ng/mL); toxicity occurs at higher levels. Signs of digoxin toxicity: anorexia, nausea, vomiting, visual disturbances (yellow-green halos around lights, blurred vision), arrhythmias including bradycardia, confusion, fatigue. Hypokalemia increases digoxin toxicity risk — monitor potassium especially in clients also taking diuretics. Antidote: digoxin immune Fab (Digibind). NCLEX commonly tests both the pre-administration check and toxicity symptoms.