NCLEX Question of the Day – Monday, April 20, 2026

Today’s question targets early recognition of medication-related harm and safe first nursing action. That skill matters because nurses are often the first to notice when a treatment is helping, failing, or causing a dangerous response. In real practice, minutes matter. You need to spot the pattern, connect it to the medication, and act in the right order.

Clinical Scenario

A 68-year-old man is admitted to a medical-surgical unit with community-acquired pneumonia. His history includes chronic kidney disease stage 3, heart failure, and atrial fibrillation. He has been taking digoxin at home for rate control. Today he reports poor appetite, nausea, and seeing “yellow halos” around the room lights. The nurse checks his vital signs: temperature 37.1 C, blood pressure 108/64 mm Hg, respiratory rate 18/min, oxygen saturation 95% on 2 L nasal cannula, and apical pulse 52/min and irregular. Morning lab results show potassium 3.0 mEq/L and creatinine 1.9 mg/dL. His scheduled digoxin dose is due now.

The Question

What is the nurse’s priority action?

Answer Choices

1. A. Administer the digoxin as prescribed and reassess the heart rate in 1 hour
2. B. Hold the digoxin dose and notify the provider of the assessment findings
3. C. Give an antiemetic for nausea and encourage oral fluids
4. D. Ask the provider for a PRN prescription for pain related to visual changes

Correct Answer

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

Detailed Rationale

This patient is showing classic signs of possible digoxin toxicity. The key clues are not just one finding, but the cluster of findings together. He has nausea, poor appetite, visual changes, bradycardia, an irregular rhythm, low potassium, and reduced kidney function. Digoxin is cleared by the kidneys. When kidney function is reduced, the drug can build up more easily. Low potassium also increases the effects of digoxin on the heart, which raises the risk for toxicity and dysrhythmias.

The nurse’s first step is to hold the medication. If a drug may be causing harm, giving more of it can make the problem worse. This is why the answer is not to monitor first after giving it. The nurse should then notify the provider promptly and report the specific findings: apical pulse 52/min and irregular, nausea, poor appetite, yellow halos, potassium 3.0 mEq/L, and creatinine 1.9 mg/dL.

After holding the dose and calling the provider, the nurse should continue with focused assessment and monitoring. That includes checking the patient’s cardiac rhythm, reassessing apical pulse, watching for worsening bradycardia or new dysrhythmias, and reviewing any recent digoxin level if available. The nurse should also monitor intake and output and review trends in renal function because impaired clearance is part of the problem.

The provider may order a serum digoxin level, repeat electrolytes, potassium replacement, and an ECG if one is not already in progress. In more severe cases, treatment may include digoxin immune Fab, especially if there are life-threatening dysrhythmias or severe symptoms. The nurse does not decide that treatment independently, but the nurse’s early recognition is what starts the safety response.

This question is really testing priority thinking. The patient is stable enough to speak and does not show airway or breathing failure, but he does have signs of a dangerous medication effect involving the heart. That makes stopping the offending medication and escalating care the safest next move.

Why the Other Options Are Wrong

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

This is unsafe. A pulse of 52/min is already below the usual hold parameter for digoxin in adults, often less than 60/min, though the exact order should be checked. More importantly, the patient has multiple toxicity clues. Reassessing after giving the drug delays the right intervention and may worsen bradycardia or trigger a more serious dysrhythmia.

C. Give an antiemetic for nausea and encourage oral fluids

This treats only one symptom and misses the cause. Nausea here is not just a comfort issue. It is a warning sign of digoxin toxicity. Encouraging fluids also does not address the immediate medication safety concern, and fluid advice may need caution in a patient with heart failure.

D. Ask the provider for a PRN prescription for pain related to visual changes

Visual changes from digoxin toxicity are not typically treated as pain. The bigger issue is the toxic effect itself. This option shows poor prioritization because it focuses on symptom control while ignoring a medication reaction that can affect cardiac conduction.

Key Takeaways

• Digoxin toxicity often shows up as nausea, vomiting, poor appetite, fatigue, visual changes, bradycardia, and dysrhythmias.
• Low potassium makes digoxin more dangerous because it increases the drug’s effect on the heart.
• Reduced kidney function raises toxicity risk because digoxin is cleared renally.
• If toxicity is suspected, do not give the next dose until the provider is notified.
• Priority nursing actions are hold the medication, assess rhythm and vital signs, review labs, and report specific findings clearly.

• On-shift mini-checklist:
• Check the apical pulse before giving digoxin.
• Review potassium and creatinine trends.
• Ask about nausea, appetite, and visual changes.
• Hold the dose if findings suggest toxicity or if the heart rate is below the ordered parameter.
• Notify the provider with exact symptoms, vitals, and lab values.
• Monitor ECG, rhythm changes, and response to any new orders.

Quick Practice Extension

1. A patient taking digoxin has an apical pulse of 58/min but denies symptoms and has normal potassium. What additional information would help you decide whether to give or hold the dose?
2. A patient with suspected digoxin toxicity develops new confusion and frequent premature ventricular contractions. What assessments and notifications become most urgent now?

Category used today: Pharmacology

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