NCLEX Question of the Day – Thursday, March 19, 2026

Today’s question targets early recognition and first-line nursing action for medication-related complications. This matters because many patient problems on a real shift start with a subtle change after a drug is given. Nurses need to spot the pattern fast, decide what is most urgent, and act before the patient declines.

Clinical Scenario

A 68-year-old man is admitted to a medical-surgical unit with community-acquired pneumonia. His history includes chronic kidney disease stage 3, atrial fibrillation, and hypertension. He is alert and oriented, and he has been receiving IV antibiotics and maintenance fluids. He develops rapid atrial fibrillation, and the provider prescribes an IV loading dose of digoxin.

Two hours after the dose, the nurse enters the room and finds the patient complaining of nausea, poor appetite, and “yellow halos” around the lights. His apical pulse is 52/min and irregular. Blood pressure is 104/62 mm Hg. Potassium from morning labs is 3.1 mEq/L. Telemetry shows frequent premature ventricular beats.

The Question

Which action should the nurse take first?

Answer Choices

1. A. Administer the next scheduled digoxin dose with food to reduce nausea
2. B. Hold digoxin, assess the patient further, and notify the provider of suspected digoxin toxicity
3. C. Encourage oral fluids and reassess the heart rate in 1 hour
4. D. Prepare to give a PRN beta blocker to control the ventricular response

Correct Answer

B. Hold digoxin, assess the patient further, and notify the provider of suspected digoxin toxicity

Detailed Rationale

This patient has several classic signs of digoxin toxicity: nausea, visual changes described as yellow halos, bradycardia, and new ventricular ectopy. The low potassium level matters because hypokalemia increases the risk of digoxin toxicity. In simple terms, when potassium is low, digoxin binds more easily and more strongly at its site of action, which raises the chance of dangerous cardiac effects.

The nurse’s first priority is safety. That means do not give more digoxin. Holding the medication prevents worsening toxicity. The next step is focused assessment and prompt provider notification because the patient already shows rhythm instability and symptoms that fit the drug reaction.

What should the nurse assess right away?

• Apical heart rate and full set of vital signs
• Telemetry rhythm for worsening dysrhythmias
• Mental status and symptom progression
• Recent lab values, especially potassium and renal function
• Medication history for drugs that increase digoxin levels or lower potassium

What should the nurse do next after holding the drug?

• Report the findings promptly to the provider
• Expect orders for a digoxin level, repeat electrolytes, and renal labs
• Place the patient on close cardiac monitoring
• Be ready to correct potassium if ordered, because low potassium can worsen the problem
• Watch for increasing bradycardia, heart block, or more frequent ventricular dysrhythmias

The big nursing judgment here is recognizing that the nausea is not just a stomach complaint. In this setting, it is part of a larger toxicity pattern. The visual changes are another major clue. When a patient on digoxin reports halos, blurred vision, or color changes, the nurse should think beyond comfort measures and look for toxicity.

Renal function also matters. Digoxin is cleared by the kidneys. A patient with chronic kidney disease may not clear the drug as well, so even a usual dose can become unsafe. That is why this scenario is high risk: older age, kidney disease, low potassium, and now clear symptoms.

Why the Other Options Are Wrong

A. Administer the next scheduled digoxin dose with food to reduce nausea

This is unsafe. Food may reduce stomach upset in some situations, but nausea here is likely a sign of toxicity, not simple irritation. Giving another dose could worsen bradycardia and dysrhythmias.

C. Encourage oral fluids and reassess the heart rate in 1 hour

This delays needed action. The patient already has a slow, irregular pulse, symptoms of toxicity, and ventricular ectopy on telemetry. Waiting an hour could allow a serious rhythm problem to develop. Fluids do not treat the underlying issue.

D. Prepare to give a PRN beta blocker to control the ventricular response

This choice ignores the current heart rate and the actual problem. The patient is now bradycardic at 52/min, not tachycardic. A beta blocker could slow conduction even more and make the situation worse. The issue is suspected digoxin toxicity, not uncontrolled rapid atrial fibrillation at this moment.

Key Takeaways

• Digoxin toxicity can show up as nausea, vomiting, poor appetite, visual changes, bradycardia, and dysrhythmias.
• Low potassium increases digoxin toxicity risk.
• Older adults and patients with kidney disease need especially careful monitoring.
• If toxicity is suspected, hold the drug first, assess, monitor rhythm, and notify the provider promptly.

What you’d do on shift:

• Check the apical pulse before giving digoxin
• Review potassium and renal labs
• Ask about nausea, vision changes, and dizziness
• Hold the medication if the pulse is low or symptoms suggest toxicity, based on facility policy and orders
• Keep the patient on telemetry and report concerning changes quickly

Quick Practice Extension

1. A patient taking digoxin has an apical pulse of 58/min before the scheduled dose and denies symptoms. What factors would guide your next nursing action?

2. A patient on digoxin starts a new loop diuretic. What assessments and teaching points would help prevent complications?

Category: Pharmacology

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