💊 Digoxin Toxicity: NCLEX Signs, Labs, and Nursing Priorities
Digoxin is a cardiac glycoside used in heart failure and atrial fibrillation. But its narrow therapeutic index makes toxicity a frequent NCLEX topic.
This KOTC blog walks you through the key signs, labs, ECG changes, and nursing actions — complete with visuals and mnemonics.
⚠️ Classic Signs of Digoxin Toxicity
| Category | Symptoms |
|---|---|
| GI | Nausea, vomiting, anorexia, abdominal pain |
| Neuro | Confusion, dizziness, fatigue, yellow/green vision |
| Cardiac | Bradycardia, AV block, dysrhythmias |
| ECG | Scooped ST segment (“Salvador Dali” appearance) |
🧪 Lab Monitoring for Digoxin
| Test | Normal Value | Toxicity Indicator |
|---|---|---|
| Digoxin Level | 0.5–2.0 ng/mL | > 2.0 ng/mL |
| Potassium (K⁺) | 3.5–5.0 mEq/L | Hypokalemia increases risk |
| Creatinine | 0.6–1.3 mg/dL | Elevated = renal impairment = toxicity risk |
🧠 NCLEX-Style Question
A patient taking digoxin reports nausea and seeing yellow halos. HR is 52 bpm. What is the nurse’s next step?
✅ Answer: Hold the medication, check digoxin level, and notify provider.
💉 Nursing Interventions
Hold digoxin for HR <60 bpm
Check digoxin and potassium levels
Administer Digibind (digoxin immune Fab) if ordered
Monitor ECG and renal function
Teach: No double dosing, avoid OTC antacids, watch for symptoms
💡 Mnemonic: “A DIG TOX”
A – Anorexia
D – Drowsiness
I – Irregular pulse
G – GI upset
T – Tinnitus or halos
O – Output ↓ (renal perfusion ↓)
X – Xanthopsia (yellow vision)
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🏁 Final Thoughts
With its narrow margin of safety and wide symptom range, digoxin is a classic NCLEX challenge. Master this drug with KOTC visuals, clear tables, and real-world examples.
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