Digoxin is not given when heart rate is?

Appeared in: HPSSC - 2015

Explanation

Digoxin is a cardiac glycoside with a negative chronotropic effect, which means it slows down the heart rate.
Standard nursing protocol requires assessing the apical pulse for one full minute before administering the drug.
For an adult patient, the medication must be withheld, and the healthcare provider notified, if the heart rate is below 60 beats per minute.
This precaution prevents inducing dangerous bradycardia or atrioventricular (AV) block.

Option A: This is not the standard threshold for withholding digoxin in an adult. A heart rate of 60-69 bpm is generally considered safe for administration, assuming no other signs of toxicity are present.
Option C: This is the standard heart rate threshold for withholding digoxin in children, not adults.
Option D: This is an incorrect threshold. A heart rate in the 70s is well within the safe range for administering digoxin to an adult.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Safe administration of cardiac glycosides (Digoxin) as background academic context rather than a clinical decision trigger.
Patient safety is paramount. Administering digoxin to a bradycardic patient can lead to life-threatening arrhythmias like complete heart block.
Always double-check electrolyte levels, especially potassium. Hypokalemia (low potassium) significantly increases the risk of digoxin toxicity, even with normal drug levels.
What if? If the patient's heart rate is 62 bpm but they report seeing yellow halos around lights and feel nauseous, the nurse should still withhold the dose and notify the provider, as these are classic signs of digoxin toxicity which can occur even with a 'safe' heart rate.

How to Approach the Question

First, identify the drug in the question: Digoxin.
Recall the primary action and major side effect of Digoxin. It strengthens heart contraction but slows the heart rate.
Remember the critical nursing safety check associated with this drug: assessing the apical pulse for one full minute before administration.
Recall the standard 'hold' parameter for an adult's heart rate, which is a key piece of factual knowledge for this medication.
Evaluate the options based on this standard parameter. Eliminate distractors, such as the parameter used for pediatric patients.

Concept Tested & Keywords

Concept Tested: Safe administration of cardiac glycosides (Digoxin)
Stem keywords: Digoxin, heart rate, not given
Lead-in keywords: is not given when
Negative lead-in flag: NOT changes the reasoning strategy; look for the exception or incorrect statement rather than the true statement.

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E6 Pharmacology Nursing Lilley 11e Part 2 pp. 77-79, 78-80

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 690-692

Practise the full HPSSC - 2015

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