A nurse is assessing a client who has heart failure and is taking digoxin. Which of the following findings should the nurse identify as an early indication of medication toxicity?

Choice A Reason:
Levothyroxine 100 mcg PO every morning is incorrect. Indicates the dosage (100 mcg) and the route (by mouth) to be taken every morning.
Choice B Reason:
Simvastatin 40 mg PO at bedtime: Specifies the dosage (40 mg) and the timing (at bedtime) for administration.
Choice C Reason:
Acetaminophen 500 mg every 4 hr RN for fever is correct. The term "RN" in this context might be interpreted as "right now" rather than the intended meaning, which could cause confusion regarding the frequency of acetaminophen administration. The nurse should seek clarification to ensure accurate and safe dosing instructions.
Choice D Reason:
Morphine 4 mg IV every 4 hr PRN for pain: Specifies the dosage (4 mg), the route (intravenous), and the frequency (every 4 hours as needed) for pain management.

Choice A Reason:
Weight gain of 0.7 kg (1.5 lb) in 24 hours is not recommendable. While sudden weight gain can indicate fluid retention, it is not a direct contraindication for administering digoxin. However, it might indicate worsening heart failure, which needs attention, but it doesn't specifically necessitate withholding digoxin.
Choice B Reason:
Urinary output 30 mL/hr is not recommendable. A low urinary output might indicate decreased kidney perfusion or renal issues. While monitoring urinary output is important, it is not a direct reason to withhold digoxin unless it's coupled with severe renal impairment or an acute kidney injury.
For a client receiving digoxin, certain findings would warrant withholding the medication due to potential complications. Among the options provided:
Choice C Reason:
Pulse rate 56/min is the correct recommendation. A low pulse rate (bradycardia), especially below 60 beats per minute, is a reason to withhold digoxin. Digoxin can further decrease the heart rate, potentially leading to excessive bradycardia or heart block. The nurse should hold the medication and consult with the healthcare provider to determine the appropriate action.
Choice D Reason:
BP 160/90 mm Hg is not recommendable. Elevated blood pressure alone is not a direct contraindication for administering digoxin to a patient with heart failure. Digoxin is not primarily used for controlling blood pressure; its use is more focused on managing heart rate and contractility in heart failure patients.