A patient is receiving digoxin. Which electrolyte imbalance must the nurse monitor most closely to prevent toxicity?

Appeared in: NORCET-11 Prelims

Explanation

Hypokalemia increases myocardial sensitivity to digoxin, raising toxicity risk.
Low potassium allows more digoxin to bind to cardiac cells, increasing its effects.
Nurses must monitor potassium levels closely in patients on digoxin, especially if also on diuretics.

Option B: Hyponatremia does not directly increase the risk of digoxin toxicity. Sodium imbalances affect cardiac function but are not the primary concern with digoxin.
Option C: Hypercalcemia can increase the risk of digoxin-induced arrhythmias but is not as critical as hypokalemia for toxicity risk.
Option D: Hypernatremia does not have a direct relationship with digoxin toxicity.

Clinical Relevance

Nursing practice connection: Use the key finding related to Electrolyte imbalance increasing risk of digoxin toxicity to guide bedside assessment, documentation, and the next nursing action.
Nurses must check potassium levels before administering digoxin and report low values to prevent toxicity.
If a patient on digoxin develops vomiting or diarrhea (which can lower potassium), extra caution is needed.
What if? If the patient is also on a potassium-wasting diuretic (like furosemide), the risk of hypokalemia and digoxin toxicity increases, requiring even closer monitoring.

How to Approach the Question

Identify the drug (digoxin) and its known risks.
Recall the mechanism of digoxin and which electrolytes affect its toxicity.
Eliminate options that are not directly linked to digoxin toxicity.
Choose the electrolyte imbalance that most increases the risk of toxicity (hypokalemia).

Concept Tested & Keywords

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E6 Pharmacology Nursing Lilley 11e Part 2 pp. 73-75, 76-78

Practise the full NORCET-11 Prelims

Attempt every question from this paper in a timed mock, then review the full solution for each one.