Apical pulse < 60, visual changes, or dig level > 2 ng/mL — hold dose and notify provider
Before you read
Test yourself first: 5 questions
Question 1 of 5
A client with severe digoxin toxicity and a life-threatening dysrhythmia is to receive an antidote. Which medication does the nurse anticipate administering?
Answer: B. Digoxin immune Fab (digoxin-specific antibody fragments) is the antidote for severe, life-threatening digoxin toxicity; it binds free digoxin and removes it from receptor sites. Atropine treats symptomatic bradycardia but is not the toxicity antidote, protamine reverses heparin, and flumazenil reverses benzodiazepines.
Question 2 of 5
A client taking a loop diuretic (furosemide) along with digoxin is at increased risk for digoxin toxicity. The nurse understands this is primarily because furosemide can cause which condition?
Answer: B. Loop diuretics such as furosemide promote potassium loss, and the resulting hypokalemia increases the heart's sensitivity to digoxin, predisposing the client to digoxin toxicity and dysrhythmias. The nurse should monitor potassium closely and watch for toxicity. Hyperkalemia, fluid overload, and hyperglycemia are not the mechanism that potentiates digoxin in this scenario.
Question 3 of 5
A client is taking a thiazide diuretic and digoxin. Which assessment finding requires the nurse to suspect digoxin toxicity related to a drug interaction?
Answer: B. Thiazide diuretics cause potassium loss; the resulting hypokalemia increases the risk of digoxin toxicity. Signs of toxicity include anorexia, nausea, visual changes (yellow-green halos), and dysrhythmias such as bradycardia. The nurse monitors potassium and digoxin levels.
Question 4 of 5
A client receiving digoxin has a potassium of 5.6 mEq/L and a digoxin level of 2.4 ng/mL with nausea and visual changes. The nurse should:
Answer: B. The digoxin level (>2.0) and symptoms indicate toxicity — hold the digoxin, notify the provider, and monitor. (Hyperkalemia can also occur with severe toxicity.) Giving the dose would worsen it.
Question 5 of 5
A client with heart failure is receiving digoxin. The nurse reviews the morning labs before administering the dose. Which result would MOST increase the risk of digoxin toxicity?
Answer: A. Hypokalemia (low potassium) increases binding of digoxin to cardiac cells and potentiates its effect, markedly raising the risk of toxicity and dysrhythmias. A normal potassium of 4.0 mEq/L, a normal sodium, or an elevated potassium would not increase toxicity risk in this way; in fact hyperkalemia tends to reduce digoxin binding.
Keep the streak going with more questions like these, each with a full rationale.
What is digoxin toxicity?
Hypokalemia, hypomagnesemia, and renal impairment all increase toxicity risk because low potassium potentiates the drug.
Key points to remember
- Early signs: anorexia, nausea, vomiting, and fatigue
- Visual disturbances — blurred or yellow-green halos around lights are classic
- Cardiac: bradycardia and new dysrhythmias
- Hold the dose and assess if apical pulse is below 60 bpm in an adult
Signs & symptoms
- Anorexia, N/V early signs
- Yellow-green halos vision
- Bradycardia, arrhythmias
Nursing priorities
- Check apical heart rate for a full minute before every dose — hold if < 60 (adult)
- Monitor digoxin level (0.5–2 ng/mL) and potassium — correct hypokalemia
- For severe toxicity, anticipate digoxin immune Fab (Digibind)
Labs & values
Patient teaching
- Take your pulse before each dose; report rate < 60, nausea, or yellow-tinged vision
- Do not double up on missed doses; eat potassium-rich foods
Red flags: report now
- Apical pulse < 60, visual changes, or dig level > 2 ng/mL — hold dose and notify provider
- Hypokalemia sharply raises toxicity risk — watch K⁺ closely with diuretics
References
Clinical references for this topic
