Which medication should be withheld if the patient’s pulse is less than 60 beats per minute?

• A. Furosemide
• B. Lisinopril
• C. Metoprolol
• D. Digoxin

Answer: (D)

When a medication affects the heart’s conduction system, you must assess the heart rate before giving it and withhold if the rate is too slow. Digoxin slows conduction through the atrioventricular (AV) node and can cause or worsen bradycardia, especially in older adults or in the setting of toxicity. Because it has a narrow therapeutic index, a pulse under 60 beats per minute is a clear signal to hold the dose and notify the clinician before administering again. This precaution helps prevent dangerous bradyarrhythmias and allows time to evaluate digoxin levels, renal function, and electrolytes, plus signs of toxicity such as nausea, confusion, or visual changes.

Furosemide and lisinopril don’t primarily slow the heart rate, so they aren’t withheld for a low pulse for that same reason. Metoprolol, a beta-blocker, can also cause bradycardia, but the item emphasizes digoxin’s specific risk of conduction slowing and toxicity, which makes withholding digoxin the most appropriate action in this scenario.