An infant is ordered a scheduled dose of Digoxin. The apical pulse rate is 78 bpm. What should the nurse do?

An infant is ordered a scheduled dose of Digoxin. The apical pulse rate is 78 bpm. What should the nurse do?

• A. Administer the dose as ordered
• B. Hold the dose and reassess the apical pulse rate in 1 hour
• C. Skip this dose but administer the next scheduled dose
• D. Hold the dose and notify the physician

Answer: (D)

Digoxin has a narrow therapeutic window and works by increasing the heart’s efficiency while also slowing the heart rate. In infants, a low apical pulse is a warning sign because giving digoxin when the heart rate is bradycardic can worsen the bradycardia or indicate early toxicity. An apical rate of 78 bpm in an infant is below the normal range, so the safest action is to hold the dose and contact the physician for guidance on whether to withhold further doses, adjust the dose, or obtain further evaluation. While awaiting orders, monitor for signs of toxicity such as poor feeding, vomiting, or arrhythmias, and review electrolytes and renal function as part of the assessment.

Digoxin has a narrow therapeutic window and works by increasing the heart’s efficiency while also slowing the heart rate. In infants, a low apical pulse is a warning sign because giving digoxin when the heart rate is bradycardic can worsen the bradycardia or indicate early toxicity. An apical rate of 78 bpm in an infant is below the normal range, so the safest action is to hold the dose and contact the physician for guidance on whether to withhold further doses, adjust the dose, or obtain further evaluation. While awaiting orders, monitor for signs of toxicity such as poor feeding, vomiting, or arrhythmias, and review electrolytes and renal function as part of the assessment.