NCLEX Question of the Day – Friday, May 29, 2026

Today’s NCLEX question targets priority nursing action in a medication safety situation. This matters in real practice because a nurse often sees early signs of harm before anyone else does. Knowing what to assess first, what to hold, and when to escalate can prevent a bad outcome from becoming an emergency.

Clinical Scenario

A 72-year-old client is admitted to a medical-surgical unit with worsening heart failure. The client has a history of atrial fibrillation, hypertension, and chronic kidney disease stage 3. Morning medications include furosemide, lisinopril, and digoxin. During assessment, the nurse notes the client reports nausea, poor appetite, and seeing “yellow halos” around the room lights. The apical pulse is 52/min and irregular. The client’s morning laboratory results show potassium 3.1 mEq/L and creatinine 1.9 mg/dL.

The Question

Which action should the nurse take first?

Answer Choices

1. Administer the scheduled digoxin and recheck the pulse in 1 hour.
2. Hold the digoxin and notify the provider of the findings.
3. Give the furosemide first to reduce fluid overload, then administer digoxin.
4. Encourage the client to eat breakfast before taking digoxin to reduce nausea.

Correct Answer

B. Hold the digoxin and notify the provider of the findings.

Detailed Rationale

This client shows several classic signs of possible digoxin toxicity: nausea, poor appetite, visual changes, and bradycardia. The low potassium level makes the situation more concerning. When potassium is low, digoxin has a stronger effect on the heart, which raises the risk of dangerous dysrhythmias. The client also has reduced kidney function, and digoxin is cleared by the kidneys. That means the medication can build up more easily.

The nurse’s first job is to recognize that giving the next dose could worsen toxicity. Holding the medication is the safest immediate step. After that, the nurse should notify the provider and be ready to report the key findings clearly: symptoms, apical pulse, potassium level, kidney function, and current cardiac history.

The nurse should also continue focused assessment. That includes checking the full set of vital signs, assessing mental status, asking about additional symptoms such as vomiting or weakness, and placing attention on cardiac monitoring if available. Because digoxin toxicity can trigger serious rhythm changes, the nurse should watch for increasing bradycardia, new ectopy, or worsening irregularity.

In practice, the provider may order a serum digoxin level, repeat electrolytes, potassium replacement, or medication changes. The nurse should not wait to act on an unsafe dose while hoping symptoms improve. Medication safety starts with recognizing when a “routine” med is no longer routine.

This question is really testing three NCLEX habits at once:

• Notice red-flag assessment findings.
• Connect those findings to the medication.
• Choose the safest first action before administration.

A useful bedside rule is this: before giving digoxin, assess the apical pulse and look at the whole picture, not just the order on the MAR. A low pulse by itself is enough to pause and reassess. When that low pulse comes with visual changes, GI symptoms, hypokalemia, and renal impairment, toxicity should move to the top of your concern list.

Why the Other Options Are Wrong

A. Administer the scheduled digoxin and recheck the pulse in 1 hour.

This is unsafe. The client already has multiple warning signs of toxicity. Rechecking later does not protect the client from harm now. A nurse should not give a medication when current assessment findings suggest it may be dangerous.

C. Give the furosemide first to reduce fluid overload, then administer digoxin.

This is also unsafe. Furosemide can lower potassium further, which may increase the toxic effects of digoxin. Even if the client has heart failure, the immediate priority is preventing medication-related harm. Fluid management matters, but not before addressing likely digoxin toxicity.

D. Encourage the client to eat breakfast before taking digoxin to reduce nausea.

This focuses on comfort instead of the real problem. The nausea is not just a mild side effect in this case. It is part of a larger cluster of findings pointing to toxicity. Giving food does not fix bradycardia, low potassium, or the risk of dysrhythmia.

Key Takeaways

• Digoxin toxicity can show up as nausea, vomiting, poor appetite, confusion, visual changes, and bradycardia.
• Low potassium raises digoxin risk because it makes the drug’s cardiac effects stronger.
• Kidney impairment matters because digoxin is cleared renally and can accumulate.
• Before giving digoxin, assess the apical pulse and review recent labs when available.
• If findings suggest toxicity, hold the medication first, then notify the provider.

What you’d do on shift:

• Check apical pulse for a full minute.
• Review potassium and renal function.
• Ask about nausea, appetite, vision changes, and weakness.
• Hold digoxin if assessment is concerning.
• Notify the provider with focused, organized data.
• Monitor rhythm, vital signs, and symptom changes closely.

Quick Practice Extension

1. A client taking digoxin has an apical pulse of 58/min but no symptoms and a normal potassium level. What additional assessment would best guide whether the medication should be given?

2. A client with heart failure is taking both furosemide and digoxin. Which daily assessment finding should the nurse teach the client to report right away at home?

Category for today: Pharmacology

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