A patient on Digoxin has an apical pulse of 61 bpm and a Digoxin level of 5 ng/mL with a potassium level of 3.3 mEq/L. What is the correct nursing action?

• A. Hold this dose and administer the second dose at 1800.
• B. Administer the dose as ordered.
• C. Hold the dose and notify the physician of the digoxin level.
• D. Hold this dose until the patient's potassium level is normal.

Answer: (C)

Digoxin has a very narrow therapeutic window, so toxicity risk is high when levels are elevated, especially with hypokalemia. A digoxin level of 5 ng/mL is well above the therapeutic range (roughly 0.5–2 ng/mL). Low potassium increases digoxin’s effects on the heart, making toxicity more likely and potentially dangerous. Because of the high digoxin level, the safest action is to hold the next dose and notify the physician promptly so orders can be given for antidotal treatment (such as digoxin-specific antibody) and potassium repletion as needed. The heart rate of 61 does not by itself mandate continuing digoxin in this toxic context, and delaying action until potassium normalizes could allow toxicity to worsen.