The nurse reviews labs: digoxin level 10 ng/mL and potassium 5.9 mEq/L. What is the nurse's primary intervention?

• A. To administer atropine
• B. To administer digoxin immune FAB
• C. To administer epinephrine
• D. To administer Kayexalate

Answer: (B)

When digoxin toxicity is suspected, the immediate aim is to neutralize the circulating digoxin. A digoxin level of 10 ng/mL plus a markedly elevated potassium (5.9 mEq/L) indicates life-threatening toxicity, so the priority is to reverse the toxin's effects. Digoxin-specific antibody fragments (Digoxin immune Fab) bind free digoxin in the bloodstream, preventing it from inhibiting the Na+/K+ ATPase. This neutralizes the toxin, helps restore normal cardiac conduction, and allows the drug to be excreted, which can rapidly reduce toxicity and improve outcomes.

Atropine might be used for symptomatic bradycardia, but it does not address the underlying toxin. Epinephrine is reserved for severe, refractory arrhythmias or cardiac arrest. Kayexalate lowers potassium by exchanging ions in the gut, but it does not treat the root cause here and is not the primary intervention for digoxin toxicity.