NCLEX Question of the Day – Friday, May 08, 2026

Today’s NCLEX question targets prioritization in medication safety, with a focus on knowing when a finding is dangerous enough to act on before giving a drug. This matters in real nursing because many serious adverse events happen when a medication is given despite a clear warning sign at the bedside. A strong nurse does not just follow the MAR. A strong nurse pauses, assesses, and protects the patient first.

Clinical Scenario

You are caring for a 72-year-old patient on a medical-surgical unit who was admitted 2 days ago with worsening shortness of breath from heart failure. The patient has a history of atrial fibrillation, hypertension, and chronic kidney disease stage 3. Current medications include furosemide, lisinopril, and digoxin 0.125 mg by mouth daily.

During your morning assessment, the patient says, “I feel more tired today, and food has tasted strange since last night.” The patient also reports mild nausea. The apical pulse is 54/min and regular. Blood pressure is 108/64 mm Hg. Oxygen saturation is 95% on 2 L nasal cannula. Morning labs show potassium 3.1 mEq/L and creatinine slightly above baseline.

The Question

Which action should the nurse take first before administering the scheduled morning digoxin?

Answer Choices

1. Administer the digoxin and recheck the heart rate in 1 hour
2. Hold the digoxin and notify the provider of the patient’s findings
3. Give the digoxin with food to reduce nausea
4. Ask the provider to prescribe an antiemetic before giving digoxin

Correct Answer

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

Detailed Rationale

This patient is showing several findings that raise concern for digoxin toxicity or, at minimum, unsafe digoxin administration. The nurse should stop and recognize the pattern before giving the medication.

First, the apical pulse is 54/min. Digoxin slows conduction through the AV node and can worsen bradycardia. In many adult patients, the nurse should question or hold digoxin when the apical pulse is below 60/min, depending on the order and agency policy. The reason is simple: giving a rate-slowing medication to a patient who is already bradycardic can push the heart rate lower and reduce cardiac output.

Second, the patient reports nausea and changes in taste. These are not random complaints in this setting. Early digoxin toxicity can cause gastrointestinal symptoms such as nausea, vomiting, and poor appetite. Patients may also describe visual or sensory changes. In an older adult, subtle symptoms matter. A nurse should not dismiss them as minor.

Third, the potassium is 3.1 mEq/L, which is low. This is a major safety clue. Hypokalemia increases the risk of digoxin toxicity because digoxin and potassium compete at the cellular level. When potassium is low, digoxin has a stronger effect, which can make toxic effects more likely even if the dose itself is not large. This patient is on furosemide, so the low potassium also fits the clinical picture.

Fourth, the creatinine is above baseline. Digoxin is cleared by the kidneys. Reduced kidney function can allow the drug to build up. In an older patient with chronic kidney disease, that risk is even higher.

The nurse’s first action is to hold the digoxin and notify the provider. Before calling, the nurse should gather key data: a full apical pulse count for 1 minute, current symptoms, recent electrolyte values, kidney function, and any rhythm information available. The nurse should be ready to report that the patient has bradycardia, nausea, altered taste, hypokalemia, and mild renal decline. These findings support withholding the medication and requesting further guidance, such as a digoxin level, potassium replacement, or ECG review.

After the call, the nurse should continue to monitor heart rate and rhythm, reassess symptoms, and watch for worsening toxicity. That includes increasing nausea, vomiting, confusion, new visual complaints, or dysrhythmias. The nurse should also monitor potassium correction and fluid status, since both affect cardiac stability.

Why the Other Options Are Wrong

A. Administer the digoxin and recheck the heart rate in 1 hour

This is unsafe because the warning signs are already present before administration. The nurse has enough evidence to suspect harm if the dose is given. Waiting until after administration could delay recognition of a preventable adverse event.

C. Give the digoxin with food to reduce nausea

This treats the symptom while ignoring the cause. Nausea here may be a sign of toxicity, not simple stomach upset. Food does not fix bradycardia, hypokalemia, or impaired renal clearance.

D. Ask the provider to prescribe an antiemetic before giving digoxin

This choice also focuses on symptom masking instead of patient safety. An antiemetic may reduce nausea, but it does nothing to address possible digoxin toxicity. It could even delay correct assessment by making the patient appear improved while the cardiac risk remains.

Key Takeaways

• Digoxin should be questioned or held when the apical pulse is low, especially below 60/min in adults unless the order says otherwise.
• Hypokalemia increases the risk of digoxin toxicity. Loop diuretics like furosemide can contribute to this problem.
• Older adults and patients with kidney disease are at higher risk because digoxin can accumulate.
• Nausea, appetite changes, weakness, and sensory changes may be early toxicity clues.
• The safest first move is often to hold the medication, assess further, and notify the provider with specific data.

What you’d do on shift:

• Check the apical pulse for a full minute before giving digoxin
• Review potassium and kidney function before administration
• Ask about nausea, appetite, vision, and fatigue
• Hold the dose if findings are concerning
• Notify the provider with clear assessment details
• Monitor rhythm, symptoms, and follow-up lab results

Quick Practice Extension

1. A patient taking digoxin develops new yellow-green visual halos but has a heart rate of 68/min. What assessment findings would most strongly support your next nursing action?

2. A patient on furosemide and digoxin has potassium 3.0 mEq/L but denies symptoms. What should the nurse prioritize before the next scheduled dose, and why?

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