Digoxin should not be given when pulse rate goes?

SGPGI Nursing Officer-2022

Medical & Surgical Nursing

Easy

Appeared in: SGPGI Nursing Officer-2022

Explanation

Digoxin is a cardiac glycoside with a negative chronotropic effect, meaning it slows the heart rate.
The standard nursing practice is to withhold digoxin if an adult patient's apical pulse is less than 60 beats per minute.
This precaution prevents iatrogenic severe bradycardia, which can compromise cardiac output and lead to symptoms like dizziness, syncope, or organ hypoperfusion.
Administering digoxin to an already bradycardic patient would dangerously potentiate this effect.

Option A: While blood pressure is an important vital sign to monitor, the primary contraindication for administering a specific dose of digoxin is the heart rate, not blood pressure.
Option C: A pulse rate greater than 100 beats/min (tachycardia) is often an indication for digoxin, particularly in conditions like atrial fibrillation, where the goal is to slow the ventricular rate.
Option D: This threshold is too high and not clinically specific. A pulse rate of 70 or 80 beats/min is below 100 but is perfectly safe for digoxin administration.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Contraindications for Digoxin Administration as background academic context rather than a clinical decision trigger.
Preventing medication errors with digoxin is a major patient safety goal due to its narrow therapeutic index (0.5-2 ng/mL).
Nurses are the last line of defense in preventing digoxin toxicity. Always perform and document the pre-administration pulse check.
What if? If a patient on digoxin has a low serum potassium level (hypokalemia), the risk of digoxin toxicity is significantly increased, even with a normal digoxin level. The nurse must report the low potassium to the provider before giving the dose, as it may need to be held regardless of the heart rate.

How to Approach the Question

First, identify the drug in the question: Digoxin.
Recall the drug class and its primary mechanism of action. Digoxin is a cardiac glycoside that slows the heart rate (negative chronotropic effect) and increases contraction force (positive inotropic effect).
The question asks when the drug should not be given. This points to a contraindication or safety precaution.
Focus on the primary safety check related to the drug's main effect. Since digoxin slows the heart rate, the key concern is causing excessive slowing (bradycardia).
Evaluate the options based on this knowledge. The standard safety protocol is to hold the dose for a pulse rate below 60 bpm in adults.
Select the option that matches this established clinical guideline.

Concept Tested & Keywords

Concept Tested: Contraindications for Digoxin Administration
Stem keywords: Digoxin, pulse rate, should not be given
Lead-in keywords: should not be given
Negative lead-in flag: NOT changes the reasoning strategy; look for the exception or incorrect statement rather than the true statement.