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)

Digoxin slows AV nodal conduction and has a narrow therapeutic index, so you must verify the heart rate carefully before dosing. Count the apical pulse for a full minute because it gives an accurate measure of rate and rhythm, which is essential since digoxin can cause or worsen bradycardia. If the apical pulse is less than 60 beats per minute, you should hold the dose and reassess. If it’s 60 or higher and there are no other contraindications, administering the dose is appropriate.