Before administering digoxin, which assessment should be performed and what is the threshold to hold the dose?

Before administering digoxin, which assessment should be performed and what is the threshold to hold the dose?

• A. Apical pulse for 1 minute; hold if HR < 60
• B. Blood pressure
• C. Respiratory rate
• D. Temperature

Answer: (A)

The essential concept is that digoxin dosing hinges on the heart rate and rhythm because digoxin slows conduction through the AV node and can cause dangerous bradycardia. The correct practice is to assess the apical pulse for a full minute and hold the dose if it is less than 60 beats per minute, since a slow rhythm increases the risk of harmful bradycardia with digoxin. Taking the apical pulse for a full minute is important because peripheral pulses can be unreliable, especially in patients with irregular rhythms or those on digoxin, so the true ventricular rate is best determined at the apex. If the apical rate is 60 or higher and there are no other contraindications, the dose can be given. The other listed measurements—blood pressure, respiratory rate, and temperature—are important vitals but do not dictate whether digoxin should be held before administration.

The essential concept is that digoxin dosing hinges on the heart rate and rhythm because digoxin slows conduction through the AV node and can cause dangerous bradycardia. The correct practice is to assess the apical pulse for a full minute and hold the dose if it is less than 60 beats per minute, since a slow rhythm increases the risk of harmful bradycardia with digoxin. Taking the apical pulse for a full minute is important because peripheral pulses can be unreliable, especially in patients with irregular rhythms or those on digoxin, so the true ventricular rate is best determined at the apex. If the apical rate is 60 or higher and there are no other contraindications, the dose can be given. The other listed measurements—blood pressure, respiratory rate, and temperature—are important vitals but do not dictate whether digoxin should be held before administration.