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NCLEX · Cardiac Care

A client with heart failure is prescribed digoxin 0.125 mg daily. Before administration, which assessment is the PRIORITY?

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Correct answer

Assess the apical pulse for 1 full minute — if below 60 bpm, hold the dose and notify the provider; also check potassium level (hypokalemia increases digoxin toxicity risk)

  1. A Ask if the client has had any chest pain
  2. B Check the client's blood pressure
  3. C Check the client's weight only
  4. D Assess the apical pulse for 1 full minute — if below 60 bpm, hold the dose and notify the provider; also check potassium level (hypokalemia increases digoxin toxicity risk)

Why this is the answer

DIGOXIN (a cardiac glycoside) has a narrow therapeutic index and specific assessment requirements before administration.

Priority assessment: APICAL PULSE — measure for a full 60 seconds; HOLD and notify provider if: below 60 bpm in adults; below 70 bpm in children; below 90 bpm in infants; POTASSIUM (K+) — hypokalemia sensitises the myocardium to digoxin toxicity; even therapeutic digoxin levels can cause toxicity when potassium is low; target K+ 3.5-5.0 mEq/L; DIGOXIN LEVEL — therapeutic range 0.5-2.0 ng/mL (though lower end preferred for heart failure); DIGOXIN TOXICITY SIGNS — early: nausea, vomiting, anorexia, visual disturbances (yellow-green halos around lights, blurred vision); cardiac: bradycardia, heart block, any new dysrhythmia.

Management of toxicity: hold digoxin; check serum level and electrolytes; provide potassium supplementation if hypokalemic; severe toxicity: Digoxin Immune Fab (DigiFab/Digibind) — specific antidote; MEDICATIONS THAT INCREASE DIGOXIN TOXICITY: hypokalemia-causing agents (loop diuretics, thiazides); antiarrhythmics (amiodarone, quinidine increase digoxin levels); verapamil.

Nursing rule: Count the pulse, check the potassium, then give digoxin.

Source: NCLEX-RN Physiological Integrity — Digoxin Administration Safety

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About this topic: Cardiac Care

Cardiac care questions cover chest pain assessment, MI and heart failure management, dysrhythmia recognition, cardiac medications and the post-procedure care after catheterisation. This is one of 10 RN: Physiological Integrity questions on cardiac care, each with a full explanation on a single study page.

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