| Course | NSG 124 Pharmacology |
|---|---|
| Unit | Unit 4 |
| Paper type | Pre-dose assessment record |
| Length | About 530 words, 4 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | BSN |
| Updated | October 2026 |
Free sample paper for NSG 124 Unit 4
Before the 0900 Digoxin: A Pre-Dose Assessment Record for an 81-Year-Old Man, With Each Item Gathered for This Drug and the Reasons It Was Held
Student Name
Department of Nursing, Herzing University
NSG 124: Pharmacology
Instructor Name
February 5, 2026
Before the 0900 Digoxin: A Pre-Dose Assessment Record for an 81-Year-Old Man, With Each Item Gathered for This Drug and the Reasons It Was Held
Patient and Order
Composite 81-year-old man, a retired upholsterer, admitted two days ago with worsening heart failure and atrial fibrillation. His diuretic dose was increased on admission. Order, exactly as written: "Digoxin 0.125 mg PO daily at 0900. Hold for apical HR less than 60 and notify prescriber."
Gathering
Each item is listed with the reason it is gathered for digoxin rather than for any medication.
| Item gathered | Finding at 0840 | Why for this drug |
|---|---|---|
| Apical pulse, full minute, with rhythm | 64, irregularly irregular | Digoxin slows conduction through the heart; the order sets a hold limit; the radial pulse can undercount in atrial fibrillation |
| Serum potassium, 0600 draw | 3.1 mmol/L (low) | Low potassium increases digoxin's binding in heart muscle and the risk of toxic rhythms even at usual levels (Pincus, 2016) |
| Serum magnesium, 0600 draw | 1.6 mg/dL (low end) | Low magnesium also raises the risk of digoxin-related rhythm problems |
| Creatinine and eGFR, 0600 draw | Creatinine 1.6 mg/dL, up from 1.2 on admission | Digoxin is cleared mainly by the kidneys; worsening kidney function raises its level |
| Digoxin level | Drawn at 0600, 1.4 ng/mL; last dose 24 hours earlier | Higher levels in heart failure were associated with higher mortality in a large trial analysis, with the best outcomes at lower levels (Rathore et al., 2003) |
| What he reports | "My stomach's off. I didn't want breakfast." Says the ceiling lights "look a bit yellow round the edges" | Nausea, loss of appetite, and changes in color vision are recognized early signs of digoxin toxicity |
| Medication list | Furosemide dose doubled on admission; no amiodarone, verapamil, or clarithromycin | Diuretics lower potassium; some drugs raise digoxin levels |
| Allergies and previous responses | No allergies. Record notes digoxin started 3 years ago without problems | A long-standing drug can still become toxic when kidney function or potassium changes |
Holding
The apical pulse of 64 was above the ordered hold limit of 60, so the order's own hold criterion was not met. The dose was held anyway, at 0850, for three reasons that together outweigh the pulse reading: a low potassium, a rising creatinine, a digoxin level of 1.4 ng/mL, and two symptoms, nausea and yellow-edged vision, that fit early toxicity. The order's hold parameter addresses heart rate only; it does not require giving the dose when other findings suggest harm, and holding a dose of this drug while the prescriber is contacted carries little risk compared with giving it.
The prescriber was called at 0855 with the findings in the order above. The response: digoxin held today; potassium replacement ordered; repeat potassium, magnesium, creatinine, and digoxin level in the morning; cardiac monitoring started; the diuretic dose to be reviewed on rounds.
What Would Have Changed the Decision
If the potassium had been in range, the creatinine unchanged, the level below 1.0 ng/mL, and he had reported no symptoms, the apical pulse of 64 would have met the order and the dose would have been given, with the pulse recorded beside it. If only one finding had been abnormal, for example a potassium of 3.4 with everything else normal, the likely course would have been to call before giving, share the finding, and follow the prescriber's decision, rather than to hold on the nurse's judgment alone. What made holding appropriate here was the combination: a drug with a narrow margin between effect and toxicity, two independent reasons for its level to be rising, a measured level already above the range associated with the best outcomes, and symptoms that fit.
Two items were considered and not gathered. An electrocardiogram was not part of the pre-dose check because the order did not require one and the call to the prescriber would decide whether one was needed; monitoring was started after the call. His weight was not used in the decision, although it is recorded daily for his heart failure, because it does not change whether this dose is safe today.
Record Entry
"0850: Digoxin 0.125 mg held. Apical HR 64 irregular. K 3.1, Mg 1.6, creatinine 1.6 (from 1.2), digoxin level 1.4 ng/mL drawn 0600. Patient reports nausea, poor appetite, yellow tinge around lights. Prescriber notified 0855; orders received for potassium replacement, repeat labs in the morning, telemetry. Patient informed dose held and why; states understanding."
Sources: the monitoring items follow the course pharmacology text (Burchum & Rosenthal, 2022); toxicity features and the role of potassium follow Pincus (2016); the significance of the level follows Rathore et al. (2003). The patient is a composite.
References
Burchum, J. R., & Rosenthal, L. D. (2022). Lehne's pharmacology for nursing care (11th ed.). Elsevier.
Pincus, M. (2016). Management of digoxin toxicity. Australian Prescriber, 39(1), 18-20. https://doi.org/10.18773/austprescr.2016.006
Rathore, S. S., Curtis, J. P., Wang, Y., Bristow, M. R., & Krumholz, H. M. (2003). Association of serum digoxin concentration and outcomes in patients with heart failure. JAMA, 289(7), 871-878. https://doi.org/10.1001/jama.289.7.871
Reading the NSG 124 Unit 4 instructions
Unit 4 asks you to record the assessment you would make before giving a specific medication. Expect to state the patient and order, list items gathered with the reason each matters for this drug, decide whether to give or hold, explain what would change the decision and write the record entry. Many versions ask how to choose items and whether to hold when a parameter is borderline. Check whether your section names the drug. Items should be specific to the drug's risks, such as electrolytes for digoxin. Hold parameters in the order are a minimum; other findings can justify holding too. Call the prescriber when you hold. The record entry should give values and the action taken.
How this NSG 124 Unit 4 example is built
It starts with the man's admission reason, current heart failure signs and the 0900 order. The gathering section lists each item and why it matters for digoxin, such as low potassium raising toxicity risk. Values are recorded beside each item. The holding section explains that the heart rate met the order's parameter but the electrolytes and kidney trend did not support giving the dose. The section on what would change the decision shows the reasoning was conditional, not reflexive. The record entry is written as it would appear in the chart, with values, the hold and the call. Drug-specific assessment, the unit's point, is visible in every line.
Where the points sit in the NSG 124 Unit 4 rubric
Herzing's rubric for a pre-dose assessment typically covers drug-specific items, reasons for each, accuracy of values, the give or hold decision, communication and documentation. Each item must be tied to digoxin's particular risks rather than to medication safety in general, and graders check those reasons first. Item points reward electrolytes, kidney function, apical pulse and toxicity symptoms. The decision earns credit when it weighs all findings, not only the order's single parameter. Communication points go to calling the prescriber promptly. Documentation should give values and the action taken. Conditional reasoning about what would change the decision is often credited. A full-minute apical pulse is expected. The record draws on Ziff and colleagues' review of digoxin safety.
NSG 124 Unit 4 help before you submit
Pre-dose records in Unit 4 commonly lose points by checking only the heart rate. Another frequent problem is giving a dose because the order's hold parameter was not met, despite other warning findings. Students often skip electrolytes and kidney function. Reasons are generic, such as for patient safety. The prescriber is not called. The record entry lacks values. Toxicity symptoms such as nausea, poor appetite and visual changes are missed. The apical pulse is taken for less than a full minute or radially. Interacting drugs, such as a new diuretic lowering potassium, are not considered. Finally, weigh every finding, because graders reward a decision that looks beyond the single number in the order.
Get a NSG 124 Unit 4 example written to your instructions
Send the Unit 4 instructions and the rubric from your NSG 124 classroom, with the order or the case the assignment supplies. We write a custom example that gathers before it holds, gives every finding a reason tied to this order, names directions rather than figures, and closes on the report. First custom sample free, returned in 24 to 48 hours.
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NSG 124 Unit 4 questions, answered
Why does the example avoid actual numbers?
Because a classroom sample that carried them would be wrong somewhere. Reference intervals and holding limits differ between texts, between laboratories and between institutions, and they are revised. Naming the parameter and the direction shows the reasoning your unit is examining, while a figure invites a correction and could be read by somebody as guidance. Put your own sourced ranges in from your classroom materials.
Do I need to include findings that were unremarkable?
Usually yes, and say they were gathered. A record showing only the findings that mattered leaves a reader unable to tell whether the rest were checked or forgotten, and several sections award credit for the completeness of the gathering. Keep the unremarkable ones brief, in the wording a record would use, and put the length into the reasons and the directions.
What if nothing in the case would hold the dose?
Then write that, and name what you were watching for anyway. A record concluding that the findings supported giving the medication is a legitimate outcome, provided the parameters that could have changed it are on the page with their directions. What loses marks is a document reaching the same conclusion without ever showing what would have altered it.
Where can I find a free NSG 124 Unit 4 sample paper?
The complete NSG 124 Unit 4 digoxin assessment record is posted here free, each item with its reason and the hold decision. A record for a different medication can be prepared on request.
What should a nurse check before giving digoxin?
An apical pulse for a full minute, potassium, magnesium, kidney function, a recent digoxin level if available and symptoms of toxicity such as nausea or visual changes. This sample holds a dose because of low potassium and rising creatinine.