An infant with a congenital heart defect is being discharged with an order for the administration of digoxin elixir every 12 hours. The parents need to be taught when administering digoxin to the infant that:

Occasionally the child may vomit. They should not repeat the dose because the amount of digoxin that was absorbed is unknown, and serum levels of digoxin that are too high are more dangerous than those that are temporarily too low. To ensure that the entire dose of digoxin is received, never mix it with food or formula. Vomiting, anorexia, and listlessness are all signs of digoxin toxicity and should be reported to the physician immediately. If a dose is forgotten for more than 6 hours, the nurse should advise the parents to skip that dose and to continue the next dose as scheduled.