NORCET 8 Prelims-2025: 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

Medical & Surgical Nursing

Easy

Appeared in: NORCET 8 Prelims-2025

Explanation

Digoxin is a cardiac glycoside that slows the heart rate (a negative chronotropic effect).
The standard nursing protocol is to withhold digoxin if an adult patient's apical pulse is less than 60 beats per minute.
The patient's pulse of 54/min indicates bradycardia, making administration unsafe as it could lead to severe heart block or other life-threatening arrhythmias.
The correct and safe nursing action is to withhold the medication and immediately notify the healthcare provider for further instructions.

Option B: This action is unsafe because it ignores the critical finding of bradycardia (pulse less than 60/min), which is a direct contraindication for administering digoxin.
Option C: Nurses are not authorized to independently alter medication dosages prescribed by a physician. This action is outside the nursing scope of practice and constitutes a medication error.
Option D: The critical safety check (pulse assessment) must be performed before administration to prevent harm. The apical pulse is also the most accurate site, not the radial. Checking after the fact does not mitigate the risk.

Clinical Relevance

Nursing practice connection: Knowing Safe administration of cardiac glycosides (Digoxin) helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Patient safety is the highest priority in medication administration. Recognizing contraindications like bradycardia before giving digoxin prevents life-threatening events.
Nurses function as a critical safety checkpoint in patient care. This responsibility involves not just following orders but using clinical judgment to assess if it is safe to do so.
What if? The patient's pulse was 62/min, but they reported seeing yellow halos around lights. The nurse should still hold the medication and notify the physician. Visual disturbances are a classic sign of digoxin toxicity, which requires intervention regardless of the heart rate being technically within the acceptable range.

How to Approach the Question

Identify the core components of the clinical scenario: the drug (digoxin), the patient type (adult), and the key clinical data (apical pulse 54/min).
Recall the primary action and major side effects of digoxin. Its main function is to increase contractility, but a critical side effect is slowing the heart rate (negative chronotropy).
Access your knowledge of the standard safety parameters for digoxin administration. The most important rule is the heart rate threshold.
Compare the patient's heart rate (54/min) to the standard threshold for adults (hold if less than 60/min).
Since 54 is less than 60, the drug must be withheld.
Evaluate the options to find the one that reflects this safe action and includes the necessary step of communicating with the provider.

Concept Tested & Keywords

Concept Tested: Safe administration of cardiac glycosides (Digoxin)
Stem keywords: digoxin, adult patient, apical pulse, 54/min
Lead-in keywords: What should the nurse do
Clinical cues: Apical pulse 54/min: This is a critical value indicating bradycardia, which is a contraindication for administering digoxin.