A patient has digoxin 0.25 mg intravenous push (IVP) prescribed. How would the nurse plan to administer this medication?

Choice A rationale Flushing with saline before administration is correct to ensure line patency, but giving a potent medication like digoxin as a rapid push is unsafe. Digoxin is a cardiac glycoside that increases the force of myocardial contraction and slows the heart rate. Normal serum levels are 0.5 to 2.0 ng/mL. Rapid administration can cause intense vasoconstriction and cardiac arrhythmias. It must be delivered slowly to allow the medication to distribute and to monitor the heart's response. Choice B rationale Administering the medication first without ensuring the line is patent is poor practice. More importantly, waiting five minutes before flushing does not address the need for a slow, controlled delivery of the drug. Digoxin must be administered slowly over at least five minutes to prevent toxic peaks and to mitigate the risk of bradycardia or heart block. Flushing after the medication is necessary to ensure the entire dose is delivered from the IV tubing into the bloodstream. Choice C rationale Injecting intravenous push medications into a primary IV bag is generally incorrect for drugs intended for rapid but controlled delivery. This dilutes the medication significantly and changes the rate of delivery to whatever the primary infusion rate is set to, rather than the intended five minute duration. Digoxin should be given as a slow direct injection or via a secondary "piggyback" if specified, but the standard protocol for IVP digoxin is slow manual administration over several minutes. Choice D rationale The safest method for administering digoxin IVP is to inject it slowly in small increments over a period of at least five minutes. This slow delivery minimizes the risk of sudden cardiac toxicity and allows the nurse to monitor the patient for adverse effects like significant bradycardia. Following the medication with a saline flush ensures the full dose reaches the patient. This controlled approach is vital because digoxin has a narrow therapeutic index and potent effects on cardiac conduction.