A patient with chronic heart failure is prescribed digoxin and hydrochlorothiazide. Which instruction is appropriate?

• A. Limit dietary sources of potassium.
• B. Take the hydrochlorothiazide before bedtime.
• C. Notify the health care provider if nausea develops.
• D. Skip the digoxin if the pulse is below 60 beats/minute.

Answer: (C)

Digoxin safety hinges on potassium levels. A thiazide diuretic like hydrochlorothiazide can lower potassium, and low potassium increases digoxin’s effect on heart cells, raising the risk of digoxin toxicity. Nausea is one of the early, common signs of this toxicity, so telling the patient to notify the health care provider if nausea develops is the right move. It prompts timely assessment of digoxin level and electrolytes and possible adjustment of therapy.

Limiting dietary potassium is not appropriate because keeping potassium in the normal range helps reduce toxicity risk. Timing the diuretic before bedtime isn’t essential to patient safety here. Automatically skipping digoxin if the pulse is under 60 isn’t the best guidance; you’d assess the pulse and symptoms and contact the provider for direction rather than making an automatic change based on heart rate alone.