A nurse is reinforcing discharge teaching with a client who will be starting a new prescription for digoxin. Which of the following instructions should the nurse include?

Digoxin is commonly prescribed for heart failure and certain dysrhythmias such as atrial fibrillation. It has a narrow therapeutic index, meaning small changes in dose can lead to toxicity. Safe administration requires monitoring the apical pulse before each dose to prevent bradycardia and other adverse effects. Patient education focuses on safe dosing, toxicity recognition, and adherence. Rationale: A. Limiting intake of foods high in potassium is incorrect because digoxin toxicity is more likely when potassium levels are low (hypokalemia), not high. Adequate potassium levels help protect the myocardium from digoxin toxicity. Therefore, patients are usually encouraged to maintain normal potassium intake unless otherwise directed. B. Checking the pulse for 1 minute before taking digoxin is essential because the medication can slow the heart rate. If the apical pulse is below the prescribed threshold (commonly <60 bpm in adults), the dose should be withheld and the provider notified. This helps prevent bradycardia and potential digoxin toxicity. C. Taking digoxin every 6 hours is incorrect because it is typically administered once daily due to its long half-life. Frequent dosing increases the risk of accumulation and toxicity. The medication schedule should always follow the prescribed once-daily regimen. D. Stating that digoxin should not be taken during pregnancy is incorrect because it may be used when clinically indicated under medical supervision. Although caution is required, digoxin is not absolutely contraindicated in pregnancy. Therapy decisions are based on maternal and fetal risk-benefit evaluation.