Tab Digoxin is withheld if the pulse rate is less than?

Appeared in: SCTIMST Staff Nurse - 2015 (Set-A)

Explanation

Digoxin has a negative chronotropic effect, meaning it slows down the heart rate.
The standard nursing protocol for adults is to withhold digoxin if the apical pulse is less than 60 beats per minute to prevent inducing dangerous bradycardia or heart block.
This threshold is a critical safety check before administration.
Assessing the apical pulse for a full minute is mandatory for accuracy before giving the drug.

Option A: A pulse rate of 40/min is already severe bradycardia. Withholding digoxin only when the pulse is this low is unsafe and significantly increases the risk of cardiac arrest.
Option B: A pulse rate of 50/min is considered bradycardia. It is not safe to wait for the heart rate to drop this low before holding the medication.
Option D: A threshold of 70/min is the standard guideline for withholding digoxin in pediatric patients (children), not adults, due to their naturally higher baseline heart rates.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Safe administration of Digoxin, a cardiac glycoside, based on heart rate monitoring as background academic context rather than a clinical decision trigger.
Accurate pulse assessment is a fundamental nursing skill crucial for patient safety during cardiac medication administration.
Hypokalemia (low potassium) increases the risk of digoxin toxicity. Nurses must monitor serum electrolyte levels, especially potassium, in patients receiving digoxin.
What if? If the patient's pulse is 62/min but they report seeing yellow halos around lights, the nurse should still withhold the dose and notify the provider, as this is a classic sign of digoxin toxicity even if the heart rate is above the threshold.

How to Approach the Question

First, identify the core of the question: it's asking for a specific numerical value related to the safe administration of a drug (Digoxin). This is a factual recall question.
Recall the pharmacological properties of Digoxin, specifically its effect on heart rate (it slows it down).
Remember the standard safety protocols for cardiac glycosides. The key is to prevent the heart rate from becoming dangerously slow.
Evaluate the options based on the standard adult threshold. Eliminate options that are too low (dangerous) or apply to different patient populations (pediatrics).
Select the option that matches the established safety guideline for an adult patient, which is 60 beats/min.

Concept Tested & Keywords

Concept Tested: Safe administration of Digoxin, a cardiac glycoside, based on heart rate monitoring.
Stem keywords: Digoxin, withheld, pulse rate
Lead-in keywords: less than

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E6 Pharmacology Nursing Lilley 11e Part 2 pp. 76-78, 73-75

E6 Nursing Vital Signs p. 79-81

Practise the full SCTIMST Staff Nurse - 2015 (Set-A)

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