NCLEX Question of the Day – Thursday, May 21, 2026

Today’s question targets early recognition of a high-risk medication complication and the nurse’s first priority action. That skill matters because many NCLEX questions are really asking whether you can spot danger early, pause, and protect the patient before the situation gets worse. In real nursing, that can prevent permanent harm.

Clinical Scenario

A 72-year-old client is admitted to a medical-surgical unit with new-onset atrial fibrillation with rapid ventricular response. The provider prescribes an intravenous dose of digoxin followed by daily oral digoxin. The client has a history of heart failure, chronic kidney disease stage 3, and hypertension. Current medications include furosemide, lisinopril, and low-dose aspirin.

On the second hospital day, the nurse enters the room to give the scheduled oral digoxin. The client says, “I feel a little sick to my stomach, and my breakfast tray looked strange this morning.” The client also reports mild fatigue. The apical pulse is 54/min and regular. Morning lab results show potassium 3.1 mEq/L and creatinine 1.8 mg/dL.

The Question

Which action should the nurse take first?

Answer Choices

1. Administer the digoxin as prescribed and recheck the heart rate in 1 hour.
2. Hold the digoxin dose and notify the provider of the client’s symptoms, pulse, and lab results.
3. Give the furosemide first to reduce cardiac workload before administering digoxin.
4. Ask the client to increase oral fluid intake and document the findings at the end of the shift.

Correct Answer

B. Hold the digoxin dose and notify the provider of the client’s symptoms, pulse, and lab results.

Detailed Rationale

This client shows several warning signs of possible digoxin toxicity or impending toxicity. The nurse should recognize the pattern, stop before giving the medication, and report it promptly.

Start with the heart rate. Digoxin slows conduction through the AV node. That can be helpful in atrial fibrillation, but it also means the nurse must assess the apical pulse before giving it. A pulse of 54/min is below the usual hold parameter for digoxin in adults. In many settings, the nurse should hold the dose if the apical pulse is under 60/min, then clarify the order or notify the provider.

Next, look at the symptoms. Nausea, fatigue, and visual changes are classic early signs associated with digoxin toxicity. The client’s statement that the breakfast tray “looked strange” suggests a visual disturbance. Even vague visual complaints matter here because digoxin can affect vision before a severe rhythm problem appears.

The lab results make the situation more concerning. The potassium is 3.1 mEq/L, which is low. Hypokalemia increases the risk of digoxin toxicity because when potassium is low, digoxin binds more strongly at its site of action. This client also takes furosemide, a loop diuretic that can lower potassium further. On top of that, the creatinine is elevated, and the client has chronic kidney disease. Digoxin is cleared by the kidneys, so impaired renal function can lead to drug buildup.

The nurse’s first action is to hold the digoxin. Giving it despite bradycardia, symptoms, and low potassium could worsen toxicity and trigger dangerous dysrhythmias. After holding the medication, the nurse should notify the provider and communicate the key findings clearly: apical pulse 54/min, nausea, visual changes, fatigue, potassium 3.1 mEq/L, and reduced kidney function.

The nurse should also continue focused assessment and monitoring. That includes checking the full set of vital signs, placing attention on cardiac rhythm, reviewing whether a serum digoxin level has been ordered, and watching for worsening symptoms such as vomiting, increasing bradycardia, confusion, or new dysrhythmias. The nurse should anticipate possible orders such as a stat digoxin level, repeat electrolytes, potassium replacement, telemetry review, or adjustment of the digoxin dose.

The key nursing judgment here is not just “know the side effects.” It is understanding why these clues matter together. Low pulse plus GI symptoms plus visual changes plus hypokalemia plus renal impairment is not a small issue. It is a stop-and-escalate situation.

Why the Other Options Are Wrong

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

This is unsafe. The nurse already has enough evidence to suspect toxicity risk. Waiting an hour after giving the drug could allow the client to deteriorate. Bradycardia and symptoms are reasons to hold, not proceed.

C. Give the furosemide first to reduce cardiac workload before administering digoxin.

This makes the problem worse. Furosemide can lower potassium further, and this client is already hypokalemic. That would increase the risk of digoxin toxicity. Also, “reduce cardiac workload” does not address the immediate safety issue.

D. Ask the client to increase oral fluid intake and document the findings at the end of the shift.

This delays needed action. Documentation is important, but it is never the priority over preventing harm. More fluids will not correct suspected digoxin toxicity in the moment, and some cardiac clients may even have fluid restrictions.

Key Takeaways

• Always check the apical pulse before giving digoxin. A low pulse can mean the dose should be held.
• Early digoxin toxicity can show up as nausea, fatigue, loss of appetite, and visual changes.
• Hypokalemia raises digoxin toxicity risk because digoxin has stronger effects when potassium is low.
• Kidney impairment matters because digoxin is renally cleared and can accumulate.
• Loop diuretics such as furosemide can contribute to low potassium and increase risk.

• On-shift mini-checklist: assess apical pulse, review potassium and creatinine, ask about GI and visual symptoms, hold digoxin if concerning findings are present, notify the provider, and continue rhythm and symptom monitoring.

Quick Practice Extension

1. A client taking digoxin has an apical pulse of 62/min but reports vomiting and seeing yellow halos around lights. What additional assessments and provider communication would you prioritize?

2. A client on digoxin and furosemide has a potassium level of 2.9 mEq/L but no symptoms yet. What nursing actions would help prevent complications before toxicity develops?

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