NCLEX Question of the Day – Tuesday, April 28, 2026

Today’s question targets prioritization in pharmacology, especially spotting a medication effect that needs immediate action. This matters in real nursing because medication problems often show up first as subtle assessment changes. A nurse who catches the pattern early can prevent a rapid decline.

Clinical Scenario

A nurse on a telemetry unit is caring for a 72-year-old client admitted 2 days ago for new-onset atrial fibrillation with rapid ventricular response. The client has a history of heart failure with reduced ejection fraction, hypertension, and chronic kidney disease stage 3. Current prescriptions include digoxin 0.125 mg by mouth daily, furosemide 40 mg IV twice daily, and potassium chloride 20 mEq by mouth daily.

During the morning assessment, the client says, “I feel weak and a little sick to my stomach. The room looks kind of yellowish.” The apical pulse is 54/min and regular. Blood pressure is 108/64 mm Hg. The client is alert and oriented. Telemetry shows sinus bradycardia. The morning laboratory results are potassium 3.0 mEq/L, creatinine 1.8 mg/dL, and digoxin level is still pending.

The Question

Which action should the nurse take first?

Answer Choices

1. A. Administer the scheduled digoxin and reassess the apical pulse in 1 hour
2. B. Hold the digoxin dose and notify the provider of the client’s findings
3. C. Give the prescribed potassium chloride and document the expected medication effects
4. D. Ask the client to describe the visual change in more detail before taking further action

Correct Answer

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

Detailed Rationale

This client has multiple signs that point to possible digoxin toxicity: nausea, weakness, yellow visual changes, and bradycardia. The potassium level is 3.0 mEq/L, which is low. That matters because hypokalemia increases the risk of digoxin toxicity. The client also has chronic kidney disease, which raises concern because digoxin is cleared by the kidneys. Poor renal clearance can let the drug build up.

The first nursing action is to hold the digoxin. Giving another dose could worsen bradycardia or trigger a dangerous dysrhythmia. Then the nurse should notify the provider promptly and report the symptoms, apical pulse, rhythm, potassium level, and renal function. These details explain why the finding is urgent.

After holding the medication and notifying the provider, the nurse should continue focused assessment. That includes checking the client’s heart rate and rhythm, blood pressure, mental status, and any worsening gastrointestinal or visual symptoms. The nurse should review whether the client has had poor oral intake, vomiting, diarrhea, or recent dose changes, because these can affect both potassium and digoxin levels.

The nurse should also anticipate follow-up orders. These may include a stat digoxin level if not already drawn, repeat electrolyte testing, potassium replacement, ECG monitoring, and changes to the medication plan. In more severe toxicity, the provider may consider digoxin immune fab, but that depends on the full clinical picture. The nurse’s role is not to diagnose independently, but to recognize the pattern, stop the immediate risk, and escalate care quickly.

Monitoring is just as important as the first call. The nurse should watch for worsening bradycardia, new ectopy, AV block, dizziness, syncope, decreased urine output, and increasing confusion. In older adults, medication toxicity can look vague at first. A client may simply say they feel “off.” That is why symptom clusters matter.

The key point is this: when a client taking digoxin has bradycardia plus classic toxicity symptoms, the nurse should not give the dose and should act immediately.

Why the Other Options Are Wrong

A. Administer the scheduled digoxin and reassess the apical pulse in 1 hour

This is unsafe. An apical pulse of 54/min is already below the usual hold parameter for digoxin in adults, often less than 60/min, depending on the order and facility policy. More importantly, the client has symptoms that strongly suggest toxicity. Reassessing later delays intervention and may worsen harm.

C. Give the prescribed potassium chloride and document the expected medication effects

Potassium replacement is likely needed, but this is not the first action. The immediate medication safety issue is the scheduled digoxin dose. The nurse must stop that risk first. Also, potassium should be given with attention to route, renal status, and repeat lab monitoring. It is part of management, not a reason to ignore a likely toxic drug effect.

D. Ask the client to describe the visual change in more detail before taking further action

More assessment can be helpful, but this option delays the priority action. The nurse already has enough data to suspect toxicity: yellow vision, nausea, weakness, bradycardia, hypokalemia, and kidney disease. In NCLEX questions, once the pattern is clear, the safest first move comes before extra discussion.

Key Takeaways

• Digoxin toxicity can show up as nausea, weakness, visual changes, confusion, and bradycardia.
• Low potassium makes digoxin effects stronger and raises toxicity risk.
• Kidney impairment increases the chance that digoxin will accumulate.
• If the pulse is low and toxicity is suspected, hold the dose and notify the provider.
• Keep the client on close cardiac monitoring and watch for rhythm changes.

• On-shift mini-checklist:
• Check apical pulse before digoxin.
• Review potassium and creatinine before giving it.
• Ask about nausea, appetite, fatigue, and vision changes.
• Hold digoxin for bradycardia or suspected toxicity.
• Report the full symptom cluster, not just one abnormal value.

Quick Practice Extension

1. A client taking digoxin has an apical pulse of 62/min, no nausea, and a potassium level of 4.2 mEq/L. What additional assessment finding would make you most concerned before giving the medication?

2. A client on furosemide and digoxin develops frequent premature ventricular contractions on telemetry. Which labs would you review first, and why?

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