NCLEX Question of the Day – Saturday, March 28, 2026

Today’s question targets early recognition of medication-related complications in a real bedside setting. This matters because nurses often see the first subtle change before a problem becomes an emergency. Knowing which finding needs action first can prevent serious harm and helps you prioritize safely under pressure.

Clinical Scenario

You are caring for a 72-year-old client on a medical-surgical unit who was admitted 2 days ago with new-onset atrial fibrillation. The client has a history of hypertension, heart failure, and chronic kidney disease stage 3. This morning, the provider started digoxin 0.125 mg by mouth daily to help with rate control. The client also takes furosemide for fluid management.

At 1000, before giving the scheduled dose, the nurse reviews the chart and performs an assessment. The apical pulse is 54/min and regular. Blood pressure is 118/66 mm Hg. The client says, “I feel a little sick to my stomach and food tastes strange today.” Morning labs show potassium 3.1 mEq/L and creatinine slightly above the client’s usual baseline.

The Question

Which action should the nurse take first?

Answer Choices

1. A. Administer the digoxin as prescribed and reassess the heart rate in 1 hour
2. B. Hold the digoxin dose and notify the provider of the client’s findings
3. C. Give the furosemide first so the client can maintain fluid balance
4. D. Ask the client to eat a snack before taking digoxin to reduce nausea

Correct Answer

B. Hold the digoxin dose and notify the provider of the client’s findings

Detailed Rationale

This question is about recognizing possible digoxin toxicity and acting before the client worsens. Several findings in the scenario point in the same direction.

First, the apical pulse is 54/min. Digoxin slows conduction through the AV node and can lower the heart rate. Before giving digoxin, the nurse should assess the apical pulse for 1 full minute. In adults, a low pulse, especially below the agency’s hold parameter or commonly below 60/min, is a reason to stop and reassess before giving the medication. Giving digoxin when the heart rate is already low can push the client into symptomatic bradycardia or other dysrhythmias.

Second, the client reports nausea and a change in taste. These are not random complaints in this setting. Early digoxin toxicity often shows up with gastrointestinal symptoms such as nausea, vomiting, poor appetite, and vague malaise. Older adults may show subtle signs first, so a nurse should take these complaints seriously even if they seem mild.

Third, the potassium is 3.1 mEq/L, which is low. This matters because low potassium increases the effect of digoxin on the heart and raises the risk of toxicity. The client is also taking furosemide, a loop diuretic that can lower potassium further. That combination is a classic setup for trouble.

Fourth, the client has chronic kidney disease and a creatinine level above baseline. Digoxin is cleared by the kidneys. Reduced renal function means the drug can accumulate more easily, especially in older adults.

So what should the nurse do? Hold the dose. Then notify the provider promptly with the specific findings: apical pulse 54/min, nausea, altered taste, potassium 3.1 mEq/L, and reduced renal function. The provider may order a digoxin level, potassium replacement, telemetry review, or a medication adjustment.

The nurse should also continue focused monitoring. Assess for dizziness, weakness, confusion, visual changes, and new dysrhythmias. Recheck vital signs, review the medication list for interactions, and monitor ECG rhythm if available. This is a good example of how assessment findings, lab values, and medication knowledge all come together in one decision.

Why the Other Options Are Wrong

A. Administer the digoxin as prescribed and reassess the heart rate in 1 hour

This is unsafe. The nurse already has enough evidence to suspect harm if the medication is given. A low apical pulse plus possible toxicity symptoms and hypokalemia should stop the nurse from administering the dose. Waiting until after administration creates unnecessary risk.

C. Give the furosemide first so the client can maintain fluid balance

This does not address the priority problem. Furosemide can worsen potassium loss, which can make digoxin toxicity more likely. Fluid balance matters, but right now the immediate safety issue is possible digoxin toxicity and bradycardia.

D. Ask the client to eat a snack before taking digoxin to reduce nausea

This treats the symptom as if it were simple stomach upset. In this case, nausea may be a warning sign, not a minor side effect to work around. The nurse should not try to mask a possible toxicity clue and then give the medication anyway.

Key Takeaways

• Check the apical pulse before giving digoxin. Bradycardia is a red flag.
• Low potassium makes digoxin more dangerous because it increases the drug’s effect on the heart.
• Older adults and clients with kidney disease are at higher risk for digoxin toxicity.
• Early toxicity may look subtle: nausea, poor appetite, weakness, or taste and vision changes.
• When several risk factors line up, hold the medication and report clearly.

• On-shift mini-checklist: verify apical pulse for 1 full minute
• review potassium and renal function before giving the dose
• ask about nausea, appetite, vision, and dizziness
• hold digoxin if findings are concerning
• notify the provider with exact assessment data and lab results
• continue monitoring heart rhythm and symptoms

Quick Practice Extension

1. A client taking digoxin reports seeing yellow halos around lights and feeling weak. What assessment and notification steps should the nurse take next?
2. A client on digoxin and a loop diuretic has a potassium level of 2.9 mEq/L but no symptoms yet. How should the nurse prioritize medication administration and follow-up?

Category: Pharmacology

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