Before administering Digoxin, the nurse's priority assessment is:

Appeared in: RML PRE 2025

Explanation

Digoxin, a cardiac glycoside, has a negative chronotropic effect, which means it slows down the heart rate.
The priority nursing action is to measure the apical pulse for a full 60 seconds before administration to obtain an accurate heart rate.
Standard protocol requires withholding the medication if an adult patient's heart rate is below 60 beats per minute to prevent severe bradycardia and potential digoxin toxicity.

Option A: Digoxin does not directly impact blood glucose metabolism or levels.
Option C: While blood pressure is monitored for the patient's overall cardiovascular status, Digoxin's primary and most immediate life-threatening effect is on heart rate and rhythm, not blood pressure.
Option D: Digoxin does not have a primary effect on the respiratory system.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Priority nursing assessment before Digoxin administration in the correct sequence, documenting the action clearly, and monitoring for the expected response.
Failure to check the apical pulse before giving Digoxin can lead to severe, life-threatening bradycardia, which is a major patient safety risk and a preventable medication error.
Nurses must also monitor serum potassium levels, as hypokalemia (low potassium) significantly increases the risk of Digoxin toxicity, even with normal drug levels.
What if? The patient is a 2-year-old child. The 'hold' parameter for heart rate would be different and higher (e.g., withhold if heart rate is less than 90-110 bpm for infants/young children), highlighting the critical need for age-specific knowledge in medication administration.

How to Approach the Question

First, identify the drug mentioned in the question: Digoxin.
Recall the primary mechanism of action and the most significant, immediate side effect of Digoxin. The key effect is its ability to slow the heart rate (negative chronotropic effect).
The question asks for the 'priority' assessment. This requires you to select the single most critical check directly related to the drug's immediate and potentially dangerous effect.
Evaluate each option based on this primary effect. Checking the heart rate directly addresses the risk of bradycardia caused by Digoxin.
Eliminate options that are not directly and immediately affected by the drug's primary mechanism (blood glucose, respiratory rate) or are of secondary importance compared to the immediate risk (blood pressure).

Concept Tested & Keywords

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E6 Pharmacology Nursing Lilley 11e Part 2 pp. 77-79, 76-78

Practise the full RML PRE 2025

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