Before giving digoxin to a patient with heart failure, how should the nurse respond if the heart rate is below 60 beats per minute?

Before giving digoxin to a patient with heart failure, how should the nurse respond if the heart rate is below 60 beats per minute?

• A. I will make adjustments in the dosage of the drug depending on what your heart rate is.
• B. I do not need to give you the drug if your heart rate is normal.
• C. I will only give you half the dosage if your heart rate is less than 60 beats per minute.
• D. I will not give the drug and report to the doctor if your heart rate is below the normal rate of 60.

Answer: (D)

Digoxin slows conduction through the AV node, which can lower the heart rate further. If the pulse is below 60 beats per minute, the safest action is to withhold the dose and promptly report to the prescriber for guidance before giving the medication. Verify the apical pulse for a full minute, and if it remains under 60, document and notify. Also assess for signs of digoxin toxicity and check relevant labs (electrolytes, particularly potassium, and renal function), since imbalances raise toxicity risk. It isn’t appropriate to adjust the dose yourself based on heart rate, give a partial dose without an order, or assume it’s safe because the rate is normal.

Digoxin slows conduction through the AV node, which can lower the heart rate further. If the pulse is below 60 beats per minute, the safest action is to withhold the dose and promptly report to the prescriber for guidance before giving the medication. Verify the apical pulse for a full minute, and if it remains under 60, document and notify. Also assess for signs of digoxin toxicity and check relevant labs (electrolytes, particularly potassium, and renal function), since imbalances raise toxicity risk. It isn’t appropriate to adjust the dose yourself based on heart rate, give a partial dose without an order, or assume it’s safe because the rate is normal.