The nurse has to instruct the patient to withhold the prescribed dose of tablet digoxin if the patient experiences?

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

Explanation

Blurred vision is a classic and specific sign of digoxin toxicity, which can also include seeing yellow, green, or white halos around objects.
Due to digoxin's narrow therapeutic index, visual disturbances are a critical warning sign that the drug level may be dangerously high.
Patients are taught to recognize this symptom, withhold the medication, and immediately notify their healthcare provider to prevent severe complications like life-threatening arrhythmias.

Option A: Joint pain (arthralgia) is not a recognized symptom of digoxin toxicity.
Option B: While chest pain is a medical emergency, it is not a specific or common sign of digoxin toxicity itself. It requires immediate evaluation for other cardiac causes like angina or myocardial infarction.
Option D: This is a desired therapeutic effect of digoxin in heart failure patients. It indicates improved cardiac function and renal perfusion, not toxicity.

Clinical Relevance

Nursing practice connection: Use the key finding related to Patient education and monitoring for digoxin toxicity to guide bedside assessment, documentation, and the next nursing action.
Nurses must educate patients on how to check their apical pulse for one full minute before taking digoxin and to hold the dose if the rate is below 60 bpm (or as per the provider's specific order).
A key patient safety intervention is monitoring serum potassium levels, as hypokalemia (low potassium) significantly increases the risk of digoxin toxicity even at therapeutic drug levels.
What if? If the patient was also taking a loop diuretic like furosemide, the risk of hypokalemia and subsequent digoxin toxicity would be much higher, requiring more frequent electrolyte monitoring and patient education on potassium-rich foods.

How to Approach the Question

First, identify the core of the question: it's asking for a symptom of digoxin toxicity that warrants holding the dose.
Recall the common signs and symptoms of digoxin toxicity. Think about the classic patient education points for this high-alert medication.
Evaluate each option: Is it a sign of toxicity, an unrelated symptom, or a therapeutic effect?
Analyze Option A (Arthralgia): This is not related to digoxin.
Analyze Option B (Chest pain): This is a serious symptom, but not specific to digoxin toxicity; it points to other urgent cardiac issues.
Analyze Option C (Blurred vision): This is a well-known, classic neuro-visual sign of digoxin toxicity.

Concept Tested & Keywords

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E6 Pharmacology Nursing Lilley 11e Part 2 pp. 73-75, 78-80, 76-78

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

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