Which of the following drug is to be withheld if the patient pulse in less than 60 per minute?

Appeared in: WCL Staff Nurse - 2019

Explanation

Digoxin is a cardiac glycoside that has a negative chronotropic effect, meaning it slows down the heart rate.
A primary safety protocol for Digoxin administration is to check the apical pulse for one full minute before giving the dose.
The medication must be withheld if the adult patient's pulse is less than 60 beats per minute to prevent severe bradycardia or atrioventricular (AV) block.
This precaution is critical because low heart rates can compromise cardiac output and lead to syncope or other serious complications.

Option B: Dopamine is a sympathomimetic agent (vasopressor/inotrope) that increases heart rate, myocardial contractility, and blood pressure.
Option C: Dobutamine is a beta-1 adrenergic agonist that primarily increases cardiac contractility and heart rate.
Option D: Phenytoin is an anticonvulsant medication. There is no standard nursing guideline to withhold this drug based on a heart rate below 60 bpm.

Clinical Relevance

Nursing practice connection: Knowing Pharmacology: Nursing Safety Protocols for Cardiac Medications helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Patient safety is paramount. The pre-administration assessment for Digoxin is a fundamental nursing responsibility that prevents life-threatening adverse events.
Always document the heart rate before administration and the rationale for withholding a dose. Promptly notify the healthcare provider when a dose is held.
What if? The patient's pulse is 62 bpm, but they report seeing yellowish halos around lights. The nurse should still withhold the dose and notify the provider, as this is a classic sign of digoxin toxicity, which can occur even with a pulse rate above the 60 bpm threshold.

How to Approach the Question

First, identify the core of the question: which medication is held for a slow heart rate (bradycardia)?
Next, review the options and classify each drug based on its primary action on the cardiovascular system.
Recall that Digoxin is a cardiac glycoside known for its negative chronotropic effect (slowing the heart rate).
Recognize that Dopamine and Dobutamine are sympathomimetics (inotropes) that stimulate the heart and increase its rate.
Identify Phenytoin as an anticonvulsant, which does not have a primary indication related to heart rate control or a standard pulse-hold parameter.
Conclude that Digoxin is the only drug among the options that is routinely withheld for a pulse rate below 60 bpm as a standard safety measure.

Concept Tested & Keywords

Q7mjRJ0o6f_D0jYZ_TgIrl

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 3 p. 34-36

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

E6 Pharmacology Katzung 16e p. 344-346

Practise the full WCL Staff Nurse - 2019

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