Which intervention by the nurse is most appropriate before digoxin administration?

HPSSC - 2015

Child Health Nursing (Pediatrics)

Hard

Appeared in: HPSSC - 2015

Explanation

Digoxin is a cardiac glycoside with a primary side effect of bradycardia (slowing of the heart rate).
The most accurate method to assess an infant's heart rate is by auscultating the apical pulse, located at the point of maximal impulse (PMI).
Counting the pulse for a full 60 seconds is mandatory to detect not only the rate but also any irregularities in rhythm, which can be a sign of toxicity.
This assessment is the most direct way to ensure the infant's heart rate is within a safe range before administering a medication known to decrease it.

Option A: While respiratory rate is an important vital sign, it is not the primary parameter to assess for safety before giving digoxin. Digoxin's main effect is on the heart rate and rhythm, not respiration.
Option C: Blood pressure is not the most critical assessment before digoxin administration. While severe toxicity can lead to hypotension, the earliest and most direct indicator of a potential adverse effect is a change in heart rate.
Option D: The radial pulse is often difficult to palpate accurately in infants due to their small size and faster heart rates. It is considered unreliable for the precise measurement required before giving digoxin. The apical pulse is the gold standard in this age group.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Medication safety and nursing responsibilities for administering Digoxin to an infant in the correct sequence, documenting the action clearly, and monitoring for the expected response.
Digoxin has a narrow therapeutic index (0.5-2 ng/mL), meaning the dose that is effective is very close to the dose that is toxic. Meticulous assessment is crucial for patient safety.
Early signs of digoxin toxicity in infants can be subtle and include poor feeding, vomiting, and lethargy, in addition to bradycardia. Nurses must educate parents on these signs.
Hypokalemia (low potassium) significantly increases the risk of digoxin toxicity. The nurse should monitor serum potassium levels, especially if the infant is also on a potassium-wasting diuretic like furosemide.

How to Approach the Question

First, identify the core subject of the question: administering digoxin to an infant.
Recall the drug class and primary action/side effect of digoxin. It is a cardiac glycoside that primarily affects heart rate.
Consider the patient population: an infant. This requires knowledge of pediatric-specific assessment techniques.
Evaluate the options based on which assessment directly monitors for the most common and dangerous side effect of the drug in this specific population.
Eliminate options that are less relevant (respiratory rate) or less accurate (radial pulse in an infant) for this specific medication safety check.
Select the option that represents the gold standard for pre-administration assessment: checking the apical pulse for a full minute.

Concept Tested & Keywords

Concept Tested: Medication safety and nursing responsibilities for administering Digoxin to an infant.
Stem keywords: intervention, nurse, digoxin administration, infant
Lead-in keywords: most appropriate
Clinical cues: The patient is an infant, which requires specific pediatric considerations for pulse assessment and medication safety.

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E6 Pharmacology Nursing Lilley 11e Part 2 pp. 77-79, 76-78