The nurse is developing a plan of care for an infant with heart failure who is receiving digoxin. The nurse would hold the dose of digoxin and notify the physician if the infant's apical pulse rate was:

Choice A rationale Digoxin is a cardiac glycoside that slows and strengthens the heart rate and is commonly used in infants with heart failure. For an infant, the normal apical pulse rate typically ranges from 100 to 160 beats per minute. A rate of 80 beats per minute is significantly below the acceptable lower limit, indicating potential digoxin toxicity or an existing underlying bradycardia, requiring the nurse to hold the dose and notify the physician immediately to prevent serious adverse effects. Choice B rationale A heart rate of 140 beats per minute is within the normal physiological range for an infant, which is generally 100 to 160 beats per minute. This rate is considered acceptable and does not warrant holding the prescribed dose of digoxin, assuming other parameters and clinical signs of toxicity are absent. Digoxin aims to improve cardiac contractility and may slightly slow the rate but 140 is a safe rate. Choice C rationale An apical pulse rate of 100 beats per minute sits at the lower boundary of the normal range for an infant, which spans from 100 to 160 beats per minute. While close to the cutoff, it is still technically acceptable for administering digoxin. The nurse would monitor closely, but the dose would generally not be withheld unless the rate was less than 90 or 100, depending on the facility policy. Choice D rationale A heart rate of 120 beats per minute is well within the expected and safe normal range for an infant, which typically extends from 100 to 160 beats per minute. This rate is adequate and does not suggest bradycardia or pose any immediate concern regarding digoxin administration. The dose should be given as scheduled, and continued monitoring should take place.