NCLEX Question of the Day – Monday, May 04, 2026

Today’s NCLEX question targets early recognition of medication-related harm and the nurse’s first priority action. This matters because many serious complications start with one subtle change in assessment. A safe nurse does not just notice the change. The nurse connects it to the medication, recognizes the risk, and acts fast enough to prevent a worse outcome.

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, stage 3 chronic kidney disease, and osteoarthritis. This morning, the client received the first dose of digoxin 0.125 mg by mouth after breakfast. Two hours later, the client tells the nurse, “I feel sick to my stomach and everything looks a little yellow.”

The nurse reviews the chart and notes these findings:

• Apical heart rate: 54/min, regular
• Blood pressure: 108/64 mm Hg
• Potassium: 3.1 mEq/L
• Creatinine: 1.9 mg/dL
• The client is also receiving furosemide daily

The Question

What is the nurse’s priority action?

Answer Choices

1. A. Administer the next scheduled dose of digoxin with food to reduce nausea
2. B. Hold digoxin and notify the provider of possible digoxin toxicity
3. C. Encourage the client to rest in bed and reassess in 4 hours
4. D. Give the prescribed furosemide now to reduce cardiac workload

Correct Answer

B. Hold digoxin and notify the provider of possible digoxin toxicity

Detailed Rationale

This client is showing several classic warning signs of digoxin toxicity. The key cues are nausea, yellow visual changes, bradycardia, low potassium, and impaired kidney function. Digoxin has a narrow therapeutic range. That means the difference between a helpful dose and a harmful dose is small. Because of that, small shifts in body chemistry can make the drug dangerous.

The nurse should first recognize that the apical pulse of 54/min is already a reason to stop and reassess before giving more digoxin. In many settings, digoxin is held if the apical pulse is below 60/min, because the drug slows conduction through the heart. Giving more when the heart rate is already low can worsen bradycardia and lead to serious dysrhythmias.

The client’s potassium is 3.1 mEq/L, which is low. This matters because low potassium increases the effects of digoxin on the heart. In simple terms, when potassium drops, digoxin can bind more strongly and act more intensely. That raises the risk for toxicity even if the prescribed dose seems reasonable.

The creatinine is 1.9 mg/dL, showing reduced kidney function. Digoxin is cleared by the kidneys. If the kidneys are not working well, the drug can build up in the body. In an older adult, that risk is even higher because drug clearance is often slower.

The client also takes furosemide, a loop diuretic that can lower potassium. This creates a common and important nursing pattern: a diuretic causes hypokalemia, hypokalemia increases digoxin sensitivity, and toxicity risk rises.

The nurse’s priority action is to hold digoxin and notify the provider right away. The nurse should also perform and document a focused assessment, including apical pulse, rhythm, blood pressure, symptoms such as nausea and visual changes, and any new confusion or weakness. The nurse should place the client on cardiac monitoring if available or increase rhythm surveillance because digoxin toxicity can trigger dangerous conduction problems.

After notifying the provider, the nurse should expect possible new orders such as a serum digoxin level, repeat potassium and magnesium levels, a 12-lead ECG, and potassium replacement if appropriate. The nurse should continue to monitor for worsening bradycardia, new dysrhythmias, vomiting, dizziness, or mental status changes. The point is not just to identify toxicity. It is to stop further exposure and catch cardiac instability early.

Why the Other Options Are Wrong

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

This is unsafe. Nausea is not just a minor stomach complaint here. It is a possible sign of toxicity. The yellow visual changes and bradycardia make that concern much stronger. Giving another dose could worsen the problem.

C. Encourage the client to rest in bed and reassess in 4 hours

Rest does not address the immediate safety issue. The client has multiple high-risk findings that point to a drug effect with potential cardiac consequences. Waiting 4 hours delays treatment and could allow a preventable dysrhythmia to develop.

D. Give the prescribed furosemide now to reduce cardiac workload

This could make the situation worse. Furosemide can lower potassium even more, and this client is already hypokalemic. Lower potassium increases the risk of digoxin toxicity. The nurse should not give a medication that may deepen the underlying problem without clarification.

Key Takeaways

• Digoxin toxicity can show up as nausea, vomiting, visual changes, bradycardia, confusion, and dysrhythmias.
• 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 because digoxin can accumulate.
• Always check the apical pulse before digoxin. A low heart rate means stop and reassess.
• When toxicity is suspected, hold the medication, assess the client, notify the provider, and monitor the heart closely.

• On-shift mini-checklist: Check apical pulse, review potassium and creatinine, ask about nausea or vision changes, hold digoxin if concerning findings are present, notify the provider, and keep close watch for rhythm changes.

Quick Practice Extension

1. A client taking digoxin reports loss of appetite and new confusion, but the heart rate is 62/min. What additional assessment finding would most increase your concern for toxicity?
2. A client on digoxin and a loop diuretic has a potassium level of 3.3 mEq/L and no symptoms yet. What nursing teaching would help reduce the risk of future toxicity?

Category for today: Pharmacology

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