A nurse is preparing to administer digoxin to an adult patient. The apical pulse is 54/min. What should the n… - NORCET 8 Prelims-2025

NORCET 8 Prelims-2025

Medical Surgical Nursing

Hard

Appeared in: NORCET 8 Prelims-2025

Explanation

The patient's apical pulse of 54 beats/min is below the standard safety threshold of 60 beats/min for an adult, a condition known as bradycardia.
Digoxin is a cardiac glycoside with a negative chronotropic effect, meaning it slows the heart rate.
Administering digoxin to a patient who is already bradycardic could dangerously lower the heart rate further, leading to severe arrhythmias or heart block.
The established nursing standard of care is to withhold the dose and immediately notify the prescribing physician for further instructions.

Option B: This action is unsafe because it ignores a clear contraindication (bradycardia) and could lead to severe adverse effects.
Option C: Nurses are not authorized to independently alter medication dosages. Doing so is a medication error and outside the scope of nursing practice.
Option D: The critical safety check must be performed before administration. Furthermore, the apical pulse is the most accurate assessment, not the radial pulse, for this medication.

Visual 1: Diagram - Anatomic illustration showing the correct placement of a stethoscope over the apex of the heart (point of maximal impulse, PMI) for accurately measuring the apical pulse.
Visual 2: Chart - A table listing the signs and symptoms of digoxin toxicity, categorized into early signs (e.g., anorexia, nausea, vomiting) and later signs (e.g., visual disturbances like yellow/green halos, cardiac arrhythmias).

Clinical Relevance

Nursing practice connection: Knowing Safe administration of cardiac glycosides (digoxin) and nursing responsibilities helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
This scenario emphasizes the nurse's crucial role as a patient safety advocate, preventing medication errors by performing critical assessments before administering high-risk drugs.
Failure to recognize and act on contraindications like bradycardia before giving digoxin can lead to life-threatening events, highlighting the importance of knowing medication-specific protocols.
What if? If the patient's serum potassium level was low (hypokalemia), the risk of digoxin toxicity would be significantly increased, even with a normal heart rate. The nurse must always review recent lab values before administration.

How to Approach the Question

Identify the core elements of the question: the drug is digoxin, the patient is an adult, and the key assessment finding is an apical pulse of 54/min.
Recall the primary action and major risks of digoxin. The key fact is its negative chronotropic effect (slows heart rate).
Remember the specific nursing safety protocol for digoxin: check the apical pulse for one full minute and hold the dose if the rate is less than 60/min for an adult.
Compare the patient's data (54/min) to the protocol threshold (less than 60/min). The patient's rate is below the threshold.
Based on this comparison, determine the correct action: withhold the drug and notify the provider.
Evaluate the options to confirm your choice. Administering the drug is unsafe, changing the dose is a medication error, and checking the pulse afterward is the wrong timing and location.

Concept Tested & Keywords

Concept Tested: Safe administration of cardiac glycosides (digoxin) and nursing responsibilities.
Stem keywords: digoxin, administer, adult patient, apical pulse, 54/min
Lead-in keywords: What should the nurse do
Clinical cues: Apical pulse 54/min: This value indicates bradycardia in an adult, which is a critical contraindication for administering digoxin.
Negative lead-in flag: false

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