Master digoxin administration and nursing considerations for the NCLEX-RN exam. This comprehensive practice set includes 30 high-yield questions with detailed rationales covering therapeutic levels, toxicity signs, administration protocols, and critical nursing interventions.
📌 Quick Digoxin Facts for NCLEX
Drug Class: Cardiac Glycoside / Inotropic Agent
Common Uses:
- Heart Failure (HF)
- Atrial Fibrillation (AFib)
- Atrial Flutter
Therapeutic Range: 0.5-2.0 ng/mL
Toxic Level: Above 2.0 ng/mL
Critical Nursing Action: Always check apical pulse for 1 full minute before administration
Hold Medication If:
- Heart rate < 60 bpm (adults)
- Heart rate < 90-110 bpm (infants/children)
Major Side Effects:
- Bradycardia
- Nausea/vomiting
- Visual disturbances (yellow-green halos)
- Dysrhythmias
30 Digoxin NCLEX Practice Questions
Question 1
A nurse is preparing to administer digoxin 0.25 mg PO to a client with heart failure. The client’s apical pulse is 58 bpm. What is the priority nursing action?
A. Administer the medication as prescribed
B. Hold the medication and notify the healthcare provider ✅
C. Give half the prescribed dose
D. Recheck the pulse in 30 minutes then give the medication
✅ Correct Answer: B
📖 Rationale: Digoxin should be withheld if the apical pulse is below 60 bpm in adults due to the risk of severe bradycardia and potential cardiac toxicity. The healthcare provider must be notified before administration to reassess the medication order. Never alter the dose without a provider’s order, and waiting to recheck is unsafe when the pulse is already critically low.
🎯 NCLEX Tip: Always assess apical pulse for a FULL 60 seconds before giving digoxin. This is a high-priority safety intervention tested frequently on NCLEX.
Question 2
A client taking digoxin reports seeing yellow-green halos around lights. What should the nurse recognize this as?
A. A normal side effect that will resolve
B. A sign of digoxin toxicity requiring immediate intervention ✅
C. An indication the dose needs to be increased
D. An unrelated vision problem
✅ Correct Answer: B
📖 Rationale: Yellow-green vision or seeing halos around lights is a classic sign of digoxin toxicity. This occurs due to the drug’s effect on color perception and indicates potentially dangerous drug levels. The nurse must hold the medication, notify the provider, and prepare to obtain a digoxin level. This is a critical safety issue requiring immediate action.
🎯 NCLEX Tip: Visual disturbances (especially yellow-green) = TOXICITY. This is a favorite NCLEX question stem.
Question 3
Before administering digoxin, the nurse reviews the client’s laboratory results. Which electrolyte imbalance increases the risk of digoxin toxicity?
A. Hyperkalemia
B. Hypokalemia ✅
C. Hypernatremia
D. Hyponatremia
✅ Correct Answer: B
📖 Rationale: Hypokalemia (low potassium) significantly increases the risk of digoxin toxicity because potassium and digoxin compete for the same binding sites on the sodium-potassium ATPase pump. When potassium is low, more digoxin binds to cardiac cells, increasing toxicity risk even at therapeutic digoxin levels. Normal potassium must be maintained (3.5-5.0 mEq/L) for safe digoxin therapy.
🎯 NCLEX Tip: Remember: LOW potassium = HIGH risk of dig toxicity. Always check K+ levels before giving digoxin.
Question 4
A client’s digoxin level is 2.4 ng/mL. Which assessment findings would the nurse expect? (Select all that apply)
A. Nausea and vomiting ✅
B. Hypertension
C. Bradycardia ✅
D. Confusion ✅
E. Tachycardia
✅ Correct Answers: A, C, D
📖 Rationale: A digoxin level of 2.4 ng/mL indicates toxicity (normal is 0.5-2.0 ng/mL). Classic signs of digoxin toxicity include gastrointestinal symptoms (nausea, vomiting, anorexia), cardiac effects (bradycardia, dysrhythmias), and neurological symptoms (confusion, fatigue, weakness). Hypotension rather than hypertension occurs, and bradycardia rather than tachycardia is expected.
🎯 NCLEX Tip: Toxicity signs: GI first, then cardiac, then neuro. Use mnemonic “NBC” – Nausea, Bradycardia, Confusion.
Question 5
A nurse is teaching a client about digoxin therapy. Which statement by the client indicates understanding?
A. “I will take my pulse and hold the medication if it’s below 60.” ✅
B. “I can take this medication with my antacids.”
C. “I should increase my intake of foods high in sodium.”
D. “If I miss a dose, I’ll take two pills the next day.”
✅ Correct Answer: A
📖 Rationale: Clients should be taught to check their pulse before each dose and withhold the medication if the pulse is below 60 bpm, notifying their provider. Antacids decrease digoxin absorption and should be separated by 2 hours. Sodium intake should be moderate and consistent. Missed doses should never be doubled as this increases toxicity risk.
🎯 NCLEX Tip: Patient teaching is HUGE on NCLEX. Know: check pulse, report toxicity signs, avoid antacids, never double doses.
Question 6
Which medication order should the nurse question for a client taking digoxin?
A. Furosemide 40 mg PO daily ✅
B. Lisinopril 10 mg PO daily
C. Aspirin 81 mg PO daily
D. Atorvastatin 20 mg PO daily
✅ Correct Answer: A
📖 Rationale: Furosemide (Lasix) is a loop diuretic that causes potassium loss. Since hypokalemia increases digoxin toxicity risk, the nurse should question this order and verify that potassium supplementation is included or potassium levels are being monitored closely. The other medications don’t have significant interactions affecting digoxin toxicity risk.
🎯 NCLEX Tip: Digoxin + loop/thiazide diuretics = risky combo. Always think about potassium loss.
Question 7
A client receiving digoxin develops atrial fibrillation with a rapid ventricular response. What is the nurse’s priority action?
A. Continue the digoxin as ordered
B. Hold the digoxin and notify the provider ✅
C. Increase the digoxin dose
D. Administer a beta blocker
✅ Correct Answer: B
📖 Rationale: New onset or worsening dysrhythmias in a client taking digoxin may indicate toxicity. Even though digoxin is used to treat atrial fibrillation, paradoxical dysrhythmias can occur with toxic levels. The medication should be held and the provider notified immediately. A digoxin level should be obtained to guide further treatment.
🎯 NCLEX Tip: ANY new cardiac rhythm changes on digoxin = think toxicity first, hold the med.
Question 8
The nurse is preparing to administer digoxin to an infant with heart failure. The infant’s apical pulse is 88 bpm. What should the nurse do?
A. Administer the medication as prescribed
B. Hold the medication and notify the provider ✅
C. Give half the dose
D. Recheck in 15 minutes
✅ Correct Answer: B
📖 Rationale: For infants, digoxin should be held if the apical pulse is below 90-110 bpm (the cutoff varies by facility policy, but 90 is commonly used). An 88 bpm heart rate is below this threshold and indicates the medication should be withheld to prevent bradycardia. The provider must be notified to reassess the order. Pediatric dosing and parameters differ significantly from adults.
🎯 NCLEX Tip: Pediatric digoxin parameters differ! Adults: hold if < 60, Infants: hold if < 90-110. Know both for NCLEX.
Question 9
A client taking digoxin and furosemide reports muscle weakness and fatigue. Which laboratory value should the nurse check first?
A. Sodium level
B. Potassium level ✅
C. Calcium level
D. Magnesium level
✅ Correct Answer: B
📖 Rationale: Muscle weakness and fatigue are classic signs of hypokalemia, which is a major concern in clients taking both digoxin and furosemide (a potassium-wasting diuretic). Hypokalemia increases the risk of digoxin toxicity significantly. The nurse should check potassium levels immediately and anticipate potassium supplementation or dietary modifications.
🎯 NCLEX Tip: Muscle weakness + digoxin + diuretic = check potassium FIRST. This combo appears frequently on NCLEX.
Question 10
Which food should the nurse encourage for a client taking digoxin and furosemide?
A. Bananas ✅
B. White bread
C. Ice cream
D. Potato chips
✅ Correct Answer: A
📖 Rationale: Bananas are high in potassium, which is essential for clients taking digoxin and loop diuretics like furosemide. Maintaining adequate potassium levels reduces the risk of digoxin toxicity. Other potassium-rich foods include oranges, tomatoes, spinach, and sweet potatoes. White bread, ice cream, and chips are low in potassium and high in sodium, which is not beneficial.
🎯 NCLEX Tip: Know your high-potassium foods: bananas, oranges, tomatoes, potatoes, spinach. Essential for digoxin patients.
NCLEX Prioritization and Delegation Practice Questions
Question 11
A client is receiving digoxin IV push. How should the nurse administer this medication?
A. Rapidly over 1 minute
B. Slowly over at least 5 minutes ✅
C. Mixed with other IV medications
D. As a rapid IV bolus
✅ Correct Answer: B
📖 Rationale: IV digoxin must be administered slowly over at least 5 minutes to prevent adverse cardiac effects, including dangerous dysrhythmias. Rapid administration can cause severe bradycardia, heart block, or cardiac arrest. The medication should never be mixed with other drugs and must be given via direct IV injection into a vein or through an IV line infusion port.
🎯 NCLEX Tip: IV digoxin = SLOW push (5+ minutes). Rapid push = cardiac arrest risk. Critical safety point!
Question 12
The antidote for severe digoxin toxicity is:
A. Protamine sulfate
B. Vitamin K
C. Digoxin immune fab (Digibind) ✅
D. Naloxone
✅ Correct Answer: C
📖 Rationale: Digoxin immune fab (Digibind) is the specific antidote for life-threatening digoxin toxicity. It works by binding to digoxin molecules in the bloodstream, making them inactive and allowing for renal elimination. It’s used when toxicity causes severe dysrhythmias, hyperkalemia, or cardiovascular collapse. The other options are antidotes for different medications (protamine for heparin, vitamin K for warfarin, naloxone for opioids).
🎯 NCLEX Tip: Know your antidotes! Digibind = digoxin, Protamine = heparin, Vitamin K = warfarin, Naloxone = opioids.
Question 13
Which client statement indicates a need for further teaching about digoxin?
A. “I’ll check my pulse before taking this medication.”
B. “I’ll take my antacid 2 hours after the digoxin.”
C. “I can crush the tablet if I have trouble swallowing.” ✅
D. “I’ll report any vision changes to my doctor.”
✅ Correct Answer: C
📖 Rationale: While many medications can be crushed, the nurse should verify this is appropriate for the specific digoxin formulation being used. Some digoxin tablets should not be crushed as it may alter absorption and lead to toxicity. The client should be instructed to consult the pharmacist or provider before crushing any cardiac medications. All other statements reflect correct understanding.
🎯 NCLEX Tip: When in doubt about crushing meds, DON’T. Check first, especially with cardiac drugs with narrow therapeutic windows.
Question 14
A client taking digoxin develops second-degree heart block. What is the priority nursing action?
A. Continue monitoring
B. Hold the digoxin and notify the provider immediately ✅
C. Administer atropine
D. Increase the digoxin dose
✅ Correct Answer: B
📖 Rationale: Heart block is a serious sign of digoxin toxicity and can progress to complete heart block or cardiac arrest. The medication must be held immediately and the provider notified for urgent intervention. A digoxin level should be obtained, and the client may need continuous cardiac monitoring. Atropine may be ordered by the provider but is not the nurse’s independent action.
🎯 NCLEX Tip: ANY conduction disturbance (heart block) on digoxin = TOXICITY. Hold immediately, notify provider.
Question 15
Which assessment finding requires immediate intervention in a client taking digoxin?
A. Apical pulse of 68 bpm
B. Blood pressure of 128/82 mmHg
C. Potassium level of 2.8 mEq/L ✅
D. Digoxin level of 1.2 ng/mL
✅ Correct Answer: C
📖 Rationale: A potassium level of 2.8 mEq/L indicates hypokalemia (normal: 3.5-5.0 mEq/L), which dramatically increases the risk of digoxin toxicity even when digoxin levels are therapeutic. This requires immediate intervention with potassium supplementation. The other values are within acceptable ranges (pulse is adequate, BP is normal, digoxin level is therapeutic).
🎯 NCLEX Tip: K+ < 3.5 + digoxin = DANGER! Address hypokalemia before giving digoxin to prevent toxicity.
Question 16
A nurse is teaching dietary modifications to a client on digoxin. Which statement is correct?
A. “Increase your intake of high-fiber foods only.”
B. “Maintain consistent potassium intake from food sources.” ✅
C. “Avoid all foods containing sodium.”
D. “Increase calcium-rich foods significantly.”
✅ Correct Answer: B
📖 Rationale: Clients on digoxin should maintain consistent potassium intake through diet, especially if also taking diuretics. Fluctuations in potassium levels can affect digoxin’s action and increase toxicity risk. Sodium should be moderate (not eliminated), fiber is beneficial but not the primary concern, and calcium doesn’t have a direct relationship with digoxin therapy like potassium does.
🎯 NCLEX Tip: CONSISTENCY is key with potassium intake on digoxin. No wild fluctuations in diet.
Question 17
Which symptom would indicate early digoxin toxicity?
A. Hypertension
B. Anorexia ✅
C. Diarrhea
D. Polyuria
✅ Correct Answer: B
📖 Rationale: Anorexia (loss of appetite) is often one of the earliest signs of digoxin toxicity, along with nausea. GI symptoms typically appear before cardiac and neurological symptoms. Hypotension (not hypertension) may occur, constipation (not diarrhea) is possible, and polyuria is not associated with digoxin toxicity.
🎯 NCLEX Tip: GI symptoms come FIRST in toxicity. Anorexia, nausea, vomiting are early warning signs.
Question 18
A client asks why they need to take digoxin for heart failure. What is the best response?
A. “It helps your heart beat faster to pump more blood.”
B. “It strengthens your heart’s contractions and slows your heart rate.” ✅
C. “It dilates your blood vessels to reduce blood pressure.”
D. “It removes excess fluid from your body.”
✅ Correct Answer: B
📖 Rationale: Digoxin has a positive inotropic effect (increases contractility/force of heart contractions) and a negative chronotropic effect (decreases heart rate). This combination improves cardiac output while reducing cardiac workload, making it effective for heart failure and certain dysrhythmias. It does not dilate vessels or act as a diuretic.
🎯 NCLEX Tip: Digoxin = stronger contractions (inotropic) + slower rate (chronotropic). Know these terms for NCLEX.
Question 19
Which vital sign must be assessed before administering digoxin?
A. Temperature
B. Blood pressure
C. Apical pulse ✅
D. Respiratory rate
✅ Correct Answer: C
📖 Rationale: The apical pulse must always be assessed for a full 60 seconds before administering digoxin because the medication slows heart rate. If the pulse is too low (< 60 bpm in adults), the medication could cause dangerous bradycardia. While blood pressure is useful information, the apical pulse is the critical assessment for safety.
🎯 NCLEX Tip: ALWAYS apical pulse × 60 seconds before digoxin. This is non-negotiable and tested repeatedly.
Question 20
A client taking digoxin reports persistent nausea for 3 days. What is the priority nursing action?
A. Administer an antiemetic
B. Hold the digoxin and notify the provider ✅
C. Encourage small frequent meals
D. Check for food poisoning
✅ Correct Answer: B
📖 Rationale: Persistent nausea in a client taking digoxin is a red flag for possible toxicity and should never be dismissed as a minor GI upset. The medication should be held and the provider notified immediately to obtain a digoxin level and assess for other signs of toxicity. While an antiemetic might be ordered, identifying and treating potential toxicity is the priority.
🎯 NCLEX Tip: Persistent GI symptoms + digoxin = assume toxicity until proven otherwise. Safety first!
Fundamentals of Nursing Questions
Question 21
Which client is at highest risk for digoxin toxicity?
A. A 45-year-old with normal renal function
B. An 82-year-old with chronic kidney disease ✅
C. A 50-year-old with hypertension
D. A 60-year-old with diabetes
✅ Correct Answer: B
📖 Rationale: Elderly clients with impaired renal function are at highest risk for digoxin toxicity because digoxin is primarily eliminated by the kidneys. Decreased renal clearance leads to drug accumulation and increased blood levels. Advanced age also reduces lean body mass and may alter drug distribution. These clients require lower doses and more frequent monitoring.
🎯 NCLEX Tip: Elderly + kidney disease + digoxin = HIGH toxicity risk. These patients need lower doses and close monitoring.
Question 22
A client taking digoxin develops atrial flutter with 2:1 block. The digoxin level is 1.8 ng/mL. What should the nurse do?
A. Continue the medication as the level is therapeutic
B. Hold the medication and notify the provider ✅
C. Increase the dose to control the rhythm
D. Switch to IV administration
✅ Correct Answer: B
📖 Rationale: Even though the digoxin level is within therapeutic range (0.5-2.0 ng/mL), the development of a new dysrhythmia suggests toxicity or adverse effect. Digoxin toxicity can occur even at therapeutic levels, especially if electrolyte imbalances exist. The medication should be held and the provider notified to assess the situation, check electrolytes, and determine if digoxin is causing or contributing to the rhythm disturbance.
🎯 NCLEX Tip: Therapeutic level ≠ no toxicity. Clinical signs trump lab values. Always assess the PATIENT first.
Question 23
Which instruction should the nurse include when teaching a client about self-administration of digoxin?
A. “Take the medication on an empty stomach for best absorption.”
B. “If you miss a dose, take two pills at the next scheduled time.”
C. “Keep a record of your daily pulse rate.” ✅
D. “You can stop taking this medication once you feel better.”
✅ Correct Answer: C
📖 Rationale: Clients should maintain a written record of daily pulse rates to help identify trends that might indicate problems. This also promotes adherence to checking pulse before each dose. Digoxin can be taken with or without food, doses should never be doubled if missed, and the medication must be taken continuously as prescribed even if symptoms improve.
🎯 NCLEX Tip: Patient self-monitoring is crucial for digoxin safety. Written pulse logs help detect problems early.
Question 24
A client taking digoxin is also prescribed amiodarone. What should the nurse monitor closely?
A. Blood glucose
B. Digoxin level ✅
C. Urinary output
D. Blood pressure only
✅ Correct Answer: B
📖 Rationale: Amiodarone significantly increases digoxin levels by decreasing its renal clearance and volume of distribution. This interaction can double digoxin levels, leading to toxicity. When amiodarone is added to a regimen that includes digoxin, the digoxin dose typically needs to be reduced by 50%, and levels should be monitored closely. This is a critical drug interaction.
🎯 NCLEX Tip: Amiodarone + digoxin = DANGER. Amiodarone increases digoxin levels significantly. Know major drug interactions!
Question 25
Which finding indicates therapeutic effectiveness of digoxin in a client with heart failure?
A. Increased heart rate
B. Decreased urinary output
C. Decreased dyspnea and edema ✅
D. Increased blood pressure
✅ Correct Answer: C
📖 Rationale: Therapeutic effectiveness of digoxin in heart failure is demonstrated by improved cardiac output, which manifests as decreased symptoms: less shortness of breath (dyspnea), reduced edema, improved activity tolerance, and decreased fatigue. The heart rate should decrease (not increase), urinary output should improve (not decrease), and blood pressure changes are variable.
🎯 NCLEX Tip: Effective digoxin therapy = fewer HF symptoms. Look for improved breathing, less swelling, better energy.
Question 26
A client is prescribed digoxin 125 mcg daily. The available tablet is 0.25 mg. How many tablets should the nurse administer?
A. 0.25 tablets
B. 0.5 tablets ✅
C. 1 tablet
D. 2 tablets
✅ Correct Answer: B
📖 Rationale: First convert to the same units: 0.25 mg = 250 mcg. Then calculate: 125 mcg ÷ 250 mcg = 0.5 tablets. The nurse should administer half of a 0.25 mg tablet. Always double-check dosage calculations for cardiac medications due to their narrow therapeutic windows. If tablets cannot be accurately split, consult pharmacy for alternative formulation.
🎯 NCLEX Tip: Watch for mcg/mg conversions! 1 mg = 1000 mcg. Double-check cardiac medication calculations always.
Question 27
Which herbal supplement should a client avoid while taking digoxin?
A. Ginger
B. St. John’s Wort ✅
C. Chamomile
D. Peppermint
✅ Correct Answer: B
📖 Rationale: St. John’s Wort can decrease digoxin levels by inducing liver enzymes that metabolize the drug and increasing P-glycoprotein activity, which pumps digoxin out of cells. This can reduce digoxin’s effectiveness and lead to treatment failure. Other herbs like hawthorn, licorice, and ginseng can also interact with digoxin. Clients should inform providers of all supplements.
🎯 NCLEX Tip: St. John’s Wort interacts with MANY drugs including digoxin. Always assess herbal use in medication history.
Question 28
A client experiences digoxin toxicity. Which medication may be administered to treat severe bradycardia?
A. Epinephrine
B. Atropine ✅
C. Lidocaine
D. Adenosine
✅ Correct Answer: B
📖 Rationale: Atropine is an anticholinergic agent that increases heart rate by blocking vagal stimulation and is the first-line treatment for symptomatic bradycardia caused by digoxin toxicity. It can be given while preparing digoxin immune fab (the definitive antidote) or if bradycardia is causing hemodynamic compromise. Temporary pacing may also be needed in severe cases.
🎯 NCLEX Tip: For dig-induced bradycardia: Atropine first, then Digibind if needed. Know emergency treatments!
Question 29
Which statement by a client indicates understanding of digoxin therapy for atrial fibrillation?
A. “This medication will convert my rhythm back to normal.”
B. “This will help control my heart rate and improve my heart’s efficiency.” ✅
C. “I need to take this medication only when I feel my heart racing.”
D. “This medication will prevent all future episodes of atrial fibrillation.”
✅ Correct Answer: B
📖 Rationale: In atrial fibrillation, digoxin is used primarily for rate control (slowing ventricular response) rather than rhythm conversion. It improves cardiac efficiency by strengthening contractions and slowing AV nodal conduction. It does not convert AFib to normal sinus rhythm or prevent all episodes, and it must be taken regularly as prescribed, not as needed.
🎯 NCLEX Tip: Digoxin for AFib = rate control, NOT rhythm conversion. Know the difference for NCLEX questions.
Question 30
A client is started on digoxin for heart failure. Which baseline assessment is most important?
A. Complete blood count
B. Liver function tests
C. Renal function and electrolytes ✅
D. Thyroid function tests
✅ Correct Answer: C
📖 Rationale: Baseline renal function (BUN, creatinine) is critical because digoxin is eliminated primarily by the kidneys, and impaired function increases toxicity risk. Electrolyte levels, especially potassium and magnesium, must be assessed because imbalances significantly affect digoxin’s safety and efficacy. These labs should be monitored regularly throughout therapy. An ECG is also important to establish baseline rhythm.
🎯 NCLEX Tip: Before starting digoxin: check kidneys (elimination), electrolytes (toxicity risk), and heart rhythm (baseline). Essential!
📚 Study Tips for Digoxin NCLEX Questions
Memory Tricks
Remember Toxicity Signs with “NAVV”:
- Nausea/vomiting
- Anorexia
- Vision changes (yellow-green)
- Ventricular dysrhythmias
Critical Numbers to Memorize:
- Therapeutic level: 0.5-2.0 ng/mL
- Hold if pulse: < 60 bpm (adults), < 90-110 bpm (infants)
- Normal potassium: 3.5-5.0 mEq/L
Drug Interactions – “DALD”:
- Diuretics (increase toxicity risk via hypokalemia)
- Amiodarone (increases digoxin levels)
- Laxatives (cause K+ loss)
- Diltiazem/verapamil (increase digoxin levels)
Common NCLEX Traps
- Therapeutic level doesn’t mean no toxicity – Clinical signs matter more than numbers
- Apical pulse must be taken for FULL 60 seconds – Not radial, not 30 seconds × 2
- Hold if < 60, not just < 50 – Don’t wait until it’s critically low
- Hypokalemia is the biggest risk factor – Always think potassium with digoxin
- Vision changes = toxicity, not normal aging – Don’t dismiss yellow-green vision
What to Watch For in Questions
- Questions about when to hold the medication (pulse parameters)
- Drug interactions, especially with diuretics and amiodarone
- Electrolyte imbalances, particularly potassium
- Signs of toxicity vs. therapeutic effects
- Patient teaching about pulse checking and reporting symptoms
- Antidote knowledge (Digibind)
- Pediatric vs. adult parameters
❓ Frequently Asked Questions
Q: What is a toxic digoxin level? A: Above 2.0 ng/mL. However, toxicity can occur even at therapeutic levels (0.5-2.0 ng/mL) if potassium is low or other risk factors are present.
Q: Why must I check my pulse before taking digoxin? A: Digoxin slows your heart rate. If your pulse is already low (below 60 bpm), taking the medication could cause dangerous bradycardia or heart block.
Q: What are the early warning signs of digoxin toxicity? A: Loss of appetite, nausea, vomiting, fatigue, and visual disturbances (seeing yellow-green halos or colors).
Q: Can I take antacids with digoxin? A: Antacids can decrease digoxin absorption. Take them at least 2 hours apart from your digoxin dose.
Q: What foods should I eat while on digoxin? A: Maintain consistent intake of potassium-rich foods like bananas, oranges, tomatoes, and leafy greens. Avoid excessive sodium.
Q: What happens if I miss a dose? A: Take it as soon as you remember if it’s within 12 hours of the scheduled time. If more than 12 hours have passed, skip it and take the next dose at the regular time. Never double up.
Q: Is digoxin safe during pregnancy? A: Digoxin crosses the placenta but is generally considered safe when necessary. However, dosing may need adjustment. Always discuss with your healthcare provider.
Q: How long does digoxin stay in my system? A: Digoxin has a half-life of 36-48 hours in patients with normal kidney function. It can take 5-7 days to reach steady state or to be eliminated after stopping.
🎯 Related NCLEX Topics
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- 🧠 NCLEX Pharmacology Questions
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- NCLEX Master Library
📊 Digoxin Toxicity vs Therapeutic Effects Comparison
| Aspect | Therapeutic Effect | Toxicity |
|---|---|---|
| Heart Rate | 60-100 bpm (controlled) | < 60 bpm (severe bradycardia) |
| Digoxin Level | 0.5-2.0 ng/mL | > 2.0 ng/mL |
| GI Symptoms | None | Nausea, vomiting, anorexia |
| Vision | Normal | Yellow-green halos, blurred |
| Energy Level | Improved, less fatigue | Weakness, confusion, fatigue |
| Cardiac Rhythm | Controlled AFib/flutter | Dysrhythmias, heart block |
| Potassium | 3.5-5.0 mEq/L (normal) | Often < 3.5 mEq/L |
| Symptoms | Reduced dyspnea, edema | Multiple system dysfunction |
💊 Digoxin Drug Interaction Quick Reference
⚠️ HIGH RISK Interactions (Increase Toxicity):
Diuretics:
- Furosemide (Lasix) – Causes K+ loss
- Hydrochlorothiazide (HCTZ) – Causes K+ loss
- Bumetanide (Bumex) – Causes K+ loss
- Action: Monitor K+ closely, consider supplementation
Antiarrhythmics:
- Amiodarone – Increases digoxin levels by 50-70%
- Quinidine – Doubles digoxin levels
- Verapamil – Increases digoxin levels by 50-75%
- Diltiazem – Increases digoxin levels
- Action: Reduce digoxin dose, monitor levels
Antibiotics:
- Erythromycin – Increases absorption
- Tetracycline – Increases absorption
- Action: Monitor for toxicity signs
⬇️ Decrease Digoxin Effectiveness:
Antacids:
- Aluminum/magnesium hydroxide
- Action: Separate by 2+ hours
Cholesterol Medications:
- Cholestyramine
- Colestipol
- Action: Give digoxin 2 hours before
Herbal Supplements:
- St. John’s Wort – Decreases levels
- Action: Avoid combination
🎓 Advanced NCLEX Concepts
NextGen NCLEX Case Study Format
Sample NGN Question:
A 78-year-old client with heart failure has been taking digoxin 0.125 mg daily and furosemide 40 mg daily for 6 months.
Current Assessment:
- Apical pulse: 52 bpm, irregular
- Blood pressure: 108/68 mmHg
- Client reports: “I haven’t felt like eating for 3 days, and everything looks yellowish”
- Lab results:
- Digoxin level: 2.6 ng/mL
- Potassium: 2.9 mEq/L
- Creatinine: 1.8 mg/dL
Select all nursing actions that apply: ☐ Hold the digoxin dose ☐ Administer potassium chloride as ordered ☐ Notify the healthcare provider immediately ☐ Administer furosemide as scheduled ☐ Continue cardiac monitoring ☐ Prepare for possible digoxin immune fab administration ☐ Encourage high-sodium foods ☐ Recheck apical pulse in 30 minutes then give digoxin
Correct Actions: Hold digoxin, administer potassium (if ordered), notify provider, continue monitoring, prepare for Digibind
📱 Download Free Resources
Get Your Free Digoxin Study Tools:
- ✅ Printable Digoxin Quick Reference Card (PDF)
- ✅ Digoxin Toxicity Signs Checklist
- ✅ 100 Additional Cardiac Medication MCQs
- ✅ NCLEX Pharmacology Study Guide
Email us→ contact@tayarimcqs.com → to get a Free PDF Bundle
✍️ Practice Application Exercise
Clinical Scenario: You are caring for Mr. Johnson, 72 years old, admitted with worsening heart failure. He has been taking digoxin 0.25 mg daily at home for 2 years.
Morning Assessment (0800):
- Vital signs: T 98.6°F, HR 54 bpm (apical), RR 22, BP 118/72
- Reports nausea and “not feeling right”
- Digoxin level drawn yesterday: 2.3 ng/mL
- Potassium level: 3.1 mEq/L
- Scheduled medications: Digoxin 0.25 mg PO at 0900
What should you do? (Priority order):
Correct Answer:
- Hold the digoxin (toxicity evident)
- Notify the healthcare provider immediately
- Continue cardiac monitoring
- Prepare to administer potassium per provider order
- Assess for additional toxicity signs
🏆 Success Tips for NCLEX Digoxin Questions
What NCLEX Examiners Look For:
1. Safety First Mentality
- Always holding medication when pulse is low
- Recognizing toxicity signs immediately
- Notifying provider before taking independent action (except holding the med)
2. Understanding of Therapeutic Range
- Not just memorizing 0.5-2.0 ng/mL
- Knowing that toxicity can occur within range
- Considering clinical picture over just numbers
3. Electrolyte Knowledge
- Connecting hypokalemia to toxicity risk
- Understanding why diuretics are dangerous with digoxin
- Knowing normal potassium range (3.5-5.0)
4. Patient Education Skills
- Teaching pulse checking technique
- Explaining what symptoms to report
- Discussing medication adherence importance
5. Critical Thinking
- Not just following orders blindly
- Questioning when something seems wrong
- Advocating for patient safety
Red Flag Phrases in NCLEX Questions:
When you see these phrases, think TOXICITY:
- “Yellow-green vision” or “halos around lights”
- “Not feeling like eating” or “persistent nausea”
- “Taking digoxin and furosemide”
- Pulse “below 60” or “in the 50s”
- Potassium “low” or specific value < 3.5
- “New irregular rhythm” or “heart block”
📝 Quick Reference Card
BEFORE giving digoxin:
✅ Check apical pulse × 60 seconds
✅ Review potassium level
✅ Check digoxin level if available
✅ Assess for toxicity signs
HOLD digoxin if:
❌ Pulse < 60 bpm (adult)
❌ Pulse < 90-110 bpm (infant)
❌ Potassium < 3.5 mEq/L
❌ Signs of toxicity present
❌ New dysrhythmias
CALL provider for:
☎️ Pulse < 60 bpm before dose
☎️ Visual disturbances (yellow-green halos)
☎️ Persistent nausea/vomiting
☎️ New or worsening dysrhythmias
☎️ Signs of heart failure worsening
☎️ Potassium abnormalities