Among the following options, identify the one which indicates the toxicity of digoxin:

Appeared in: AIIMS Delhi NO-2016

Explanation

Visual disturbances, particularly xanthopsia (seeing yellow-green halos around lights), are a classic and specific sign of the central nervous system effects of digoxin toxicity.
While gastrointestinal symptoms like anorexia and nausea are often the earliest signs to appear, visual changes are a more definitive indicator that toxicity is developing.
Other neurological signs that accompany visual disturbances include headache, fatigue, confusion, and dizziness.

Option B: Muscle cramping is not a direct sign of digoxin toxicity.
Option C: Constipation is incorrect because digoxin toxicity typically stimulates the gastrointestinal tract.
Option D: Tinnitus (ringing in the ears) is not a recognized symptom of digoxin toxicity.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Signs and symptoms of digoxin toxicity as background academic context rather than a clinical decision trigger.
A core nursing responsibility is to assess the apical pulse for one full minute before administering digoxin. The dose must be held and the provider notified if the pulse is below 60 bpm in an adult, as bradycardia is a key sign of toxicity.
Patient education is critical. Nurses must teach patients and their families to recognize and report early signs of toxicity, especially loss of appetite, nausea, vomiting, or any changes in vision.
What if? If the patient is also prescribed a potassium-wasting diuretic like furosemide, the nurse's vigilance for toxicity must be heightened. The risk of digoxin toxicity is dramatically increased by hypokalemia, so monitoring potassium levels is a top priority.

How to Approach the Question

First, identify the keyword in the question: 'digoxin toxicity'. This tells you the question is a factual recall about a specific drug's adverse effects.
Recall the major signs of digoxin toxicity. Remember that it has a narrow therapeutic window and affects multiple body systems (GI, cardiac, CNS).
Evaluate each option against your knowledge. 'Visual disturbances' should stand out as a classic, textbook sign.
Analyze the distractors to confirm your choice. 'Cramping' is related to potassium, which is linked to digoxin but isn't a direct sign. 'Constipation' is the opposite of the actual GI effect (diarrhea). 'Tinnitus' points to a different drug class (salicylates).
This process of elimination confirms that visual disturbances is the most accurate and specific indicator of digoxin toxicity among the choices provided.

Concept Tested & Keywords

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E6 Pharmacology Nursing Lilley 11e Part 2 p. 73-75

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 758-760

Practise the full AIIMS Delhi NO-2016

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