What is the most important nursing action prior to administering digoxin to a client with heart failure?

• A. Use the pulse reading from the electronic blood pressure device
• B. Assess the apical pulse, counting for a full 60 seconds
• C. Take a radial pulse, counting for a full 60 seconds
• D. Check for a pulse deficit at least twice with another nurse

Answer: (B)

Assessing the apical pulse and counting for a full 60 seconds is critical prior to administering digoxin because this medication has the potential to significantly alter heart rhythm and rate. Digoxin works by increasing the strength of the heart's contractions and can cause bradycardia, which is a slower than normal heart rate.

Taking the apical pulse allows the nurse to directly assess the heart’s rhythm and rate, as this is where the heartbeat can be most accurately measured. By counting for a full 60 seconds, the nurse ensures that any variations in heart rate are captured, especially since some arrhythmias could occur. If the heart rate is below a certain threshold (usually 60 beats per minute), it may be necessary to hold the medication and notify the healthcare provider.

This action is vital in ensuring patient safety, as administering digoxin with a significantly low heart rate can lead to serious complications, such as further cardiac suppression or even toxicity.