Before administering digoxin, you must check which of the following?

IGNOU Post B. SC. Nursing entrance -2021

Nursing Foundation

Easy

Appeared in: IGNOU Post B. SC. Nursing entrance -2021

Explanation

Digoxin is a cardiac glycoside with a negative chronotropic effect, which means it slows the heart rate.
To prevent dangerous bradycardia (an abnormally slow heart rate), the nurse must assess the patient's apical pulse for one full minute before administration.
Standard protocol requires withholding the dose if an adult's pulse is below 60 beats per minute.
This assessment is the most critical safety check directly related to digoxin's primary mechanism of action and potential for adverse effects.

Option A: While assessing breathing is part of a standard vital signs check, digoxin's primary and immediate effect is on the heart rate, not the respiratory rate. Changes in breathing would be a later or indirect sign of severe cardiac compromise, not the initial parameter to check for safety before administration.
Option B: Temperature is not directly affected by the administration of digoxin. While fever can increase heart rate and metabolic demand, it is not the specific parameter that must be checked to ensure the safe administration of this particular drug.
Option D: While confusion or a change in consciousness can be a sign of advanced digoxin toxicity, it is not the routine check performed before every dose. The pulse rate is the most immediate and sensitive parameter to assess for the risk of bradycardia.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Nursing responsibilities before digoxin administration as background academic context rather than a clinical decision trigger.
Checking the apical pulse before giving digoxin is a fundamental patient safety measure to prevent life-threatening bradycardia and heart block. This is a non-negotiable nursing responsibility.
Nurses must educate patients and their families on how to take a pulse and recognize the signs of toxicity (nausea, vision changes), especially if the patient is being discharged on digoxin.
What if? The patient's lab results show a low potassium level (hypokalemia). In this case, the nurse must hold the digoxin dose and immediately notify the provider. Hypokalemia dramatically increases the heart's sensitivity to digoxin, raising the risk of toxicity even at a therapeutic drug level.

How to Approach the Question

First, identify the key medication in the question: digoxin.
Recall the drug class and primary mechanism of action. Digoxin is a cardiac glycoside that slows the heart rate (negative chronotropic effect).
Think about the most direct and immediate risk associated with this action. The main risk is causing the heart rate to become too slow (bradycardia).
Evaluate the options to see which one directly measures the parameter affected by the drug's primary risk. Checking the pulse rate is the direct assessment for bradycardia.
Eliminate the other options as they are not the primary, specific safety check required for digoxin. Breathing, temperature, and consciousness are general assessments, but the pulse rate is the critical one for this medication.

Concept Tested & Keywords

QyEXqa8QBFd11xvGlFQ3AQ

E6 Pharmacology Nursing Lilley 11e Part 2 p. 76-78

E6 Nursing Fundamentals Potter Perry 12e Part 3 p. 43-45