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Difficulty: EasyPharmacological Therapies

A practical nurse is preparing to administer a scheduled dose of oral digoxin to an adult client. Prior to administration, the nurse auscultates the client's apical pulse and notes a rate of 5454 beats per minute. Which of the following actions should the practical nurse take?

  1. A
    Administer the medication as prescribed and document the findings.
  2. B
    Assess the client's radial pulse for 3030 seconds to confirm the rate.
  3. Withhold the medication and report the heart rate to the registered nurse.Answer
  4. D
    Administer half of the prescribed dose to prevent further bradycardia.

Answer

Withhold the medication and report the heart rate to the registered nurse.
Digoxin is a cardiac glycoside that slows the heart rate. The standard nursing safety protocol is to withhold the medication and notify the supervising registered nurse or healthcare provider if an adult client's apical pulse is less than 6060 beats per minute, as administering it could cause severe, symptomatic bradycardia or indicate medication toxicity.

Step-by-Step Solution

1
Analyze the client's pre-administration clinical data.
The client has an apical pulse of 5454 beats per minute.
Cardiac glycosides like digoxin require a current heart rate assessment before every dose.
2
Compare the assessment finding to standard safe administration parameters.
The heart rate of 5454 beats per minute is below the standard adult minimum threshold of 6060 beats per minute.
Digoxin exerts a negative chronotropic effect, meaning it further slows down the heart rate.
3
Identify the safest action within the practical nurse's scope of practice.
The nurse must safely withhold the medication and escalate the finding.
Administering the medication could cause harm, and altering the dose is outside the PN scope. The RN or provider must evaluate the client.

Key Concept

Pre-administration Assessment and Safe Medication Practices for Cardiac Glycosides
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Topics

Pharmacological Therapies

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