After realizing that she administered 0.25 mg of digoxin instead of the prescribed 0.125 mg, what should be the nurse's next step?

When a nurse administers twice the prescribed dose of digoxin, the immediate priority is to notify the healthcare provider and follow their instructions. Digoxin has a very narrow therapeutic index, and a dose of 0.25 mg when only 0.125 mg was prescribed doubles the exposure, placing the client at significant risk of digoxin toxicity, which can cause life-threatening dysrhythmias, nausea, visual disturbances, and bradycardia. The provider must be informed right away so that appropriate interventions — such as increased monitoring, serum digoxin level measurement, or antidotal treatment with digoxin immune fab — can be ordered promptly. Reassuring the patient that the dose is correct is unethical, constitutes falsification, and violates the nurse's duty of disclosure. Administering activated charcoal without a provider order and without proper indication is outside the nurse's independent scope of practice for this situation. While monitoring the patient for toxicity and documenting the error are important components of the response, they should occur after notifying the provider, not instead of it. Timely provider notification is always the first step in managing a medication error involving a high-alert drug like digoxin.