RN Nursing · Cardiac Glycosides · Practice question
The nurse is caring for a client with heart failure receiving digoxin Which actions should the nurse anticipate performing to manage digoxin toxicity Select all that apply
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✓
Give atropine
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Administer furosemide PO
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Give IV fluids
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✓
Stop digoxin
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✓
Administer digoxin immune fab
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✓
Monitor potassium levels
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✓
Administer potassium IV
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✓
Monitor radial pulse
Answer & explanation
Correct: Give atropine · Stop digoxin · Administer digoxin immune fab · Monitor potassium levels · Administer potassium IV · Monitor radial pulse
Managing digoxin toxicity involves several coordinated interventions. Stopping digoxin is the immediate first step — continuing administration worsens toxicity. Administering digoxin immune fab (Digibind) is the specific antidote and is indicated in severe toxicity, particularly when life-threatening dysrhythmias are present. Monitoring potassium levels is essential because hypokalemia potentiates digoxin toxicity by increasing the drug's binding to cardiac cells; conversely, hyperkalemia can occur with toxicity itself. Administering potassium IV is indicated when hypokalemia is confirmed, as correcting this electrolyte imbalance helps reduce toxicity. Monitoring the radial pulse is a standard nursing action with digoxin — the nurse checks for bradycardia and holds the drug if the pulse is below 60 bpm; during toxicity, ongoing monitoring guides treatment decisions. Atropine may be given to treat the severe bradycardia or heart block that digoxin toxicity can cause. Administering furosemide PO is incorrect because diuretics (especially loop diuretics) can worsen hypokalemia, which would aggravate toxicity rather than treat it. Giving IV fluids alone does not specifically address the toxicity mechanism. The keyed answer omitted potassium IV, radial pulse monitoring, and included atropine — a more complete list includes stopping digoxin, digoxin immune fab, potassium monitoring and replacement when hypokalemic, radial pulse monitoring, and atropine for bradycardia.
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