NCLEX Question of the Day – Saturday, May 30, 2026

Today’s question targets priority nursing action in a time-sensitive medication problem. This matters in real nursing because the safest nurse is the one who notices early signs of harm, connects them to the medication list, and acts before the patient declines. For NCLEX, this means looking past the diagnosis alone and focusing on what is most dangerous right now.

Clinical Scenario

A 76-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 the nurse’s assessment at 0900, the client says, “I feel sick to my stomach and everything looks a little yellow.” The client is alert but tired. Apical pulse is 52/min and regular, blood pressure is 108/64 mm Hg, respirations are 18/min, and oxygen saturation is 96% on room air. The basic metabolic panel from this morning shows potassium 3.0 mEq/L and creatinine 1.8 mg/dL.

The Question

Which action should the nurse take first?

Answer Choices

1. A. Administer the scheduled digoxin and reassess the apical pulse in 1 hour
2. B. Hold the digoxin dose and notify the provider of the client’s findings
3. C. Give the prescribed furosemide because fluid overload is the main concern
4. D. Encourage the client to eat a banana and document the symptoms

Correct Answer

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

Detailed Rationale

This client is showing classic signs that should make the nurse suspect digoxin toxicity. The key clues are nausea, yellow visual changes, and bradycardia. The low potassium level matters because hypokalemia increases the effects of digoxin on the heart. Chronic kidney disease also matters because digoxin is cleared through the kidneys, so impaired renal function raises the risk of drug buildup.

The first nursing action is to hold the digoxin. Giving another dose could worsen toxicity and push the client into a more dangerous dysrhythmia. The nurse should then notify the provider promptly and report the most important findings in a focused way: apical pulse 52/min, nausea, yellow vision changes, potassium 3.0 mEq/L, and creatinine 1.8 mg/dL.

After holding the medication and calling the provider, the nurse should continue with targeted assessment and monitoring. That includes checking the client’s cardiac rhythm, reassessing heart rate and blood pressure, reviewing the medication administration record for other drugs that affect potassium or heart rate, and preparing for additional orders. Common next steps may include a serum digoxin level, repeat electrolyte testing, potassium replacement, and an ECG. If the client becomes unstable, develops severe bradycardia, or shows new dysrhythmias, the nurse would escalate care immediately.

The reason this is the priority is simple: this is not just a side effect problem. It is a patient safety problem involving a high-alert medication with cardiac effects. On NCLEX, when a medication is likely causing active harm, stopping the next dose and reporting urgent findings is often the safest first move.

Why the Other Options Are Wrong

A. Administer the scheduled digoxin and reassess the apical pulse in 1 hour

This is unsafe. An apical pulse of 52/min is already below the usual hold parameter for digoxin in adults, commonly less than 60/min, though the exact order should be checked. More important, the client has multiple toxicity signs, not just a low pulse. Reassessing later delays treatment while exposing the client to more drug.

C. Give the prescribed furosemide because fluid overload is the main concern

This choice misses the immediate danger. Furosemide can worsen potassium loss, and this client’s potassium is already 3.0 mEq/L. Lower potassium can make digoxin toxicity worse and increase the risk for serious dysrhythmias. Heart failure is important, but the question asks what the nurse should do first based on the current findings.

D. Encourage the client to eat a banana and document the symptoms

This is incomplete and too slow for the situation. A banana will not correct significant hypokalemia quickly enough, and food alone does not address possible toxicity. Documentation is necessary, but it never replaces immediate clinical action when a patient may be in danger.

Key Takeaways

• Digoxin toxicity can show up as nausea, vomiting, fatigue, visual changes, and bradycardia.
• Hypokalemia makes digoxin more dangerous because it increases the drug’s effect on the heart.
• Kidney impairment raises toxicity risk because digoxin is cleared renally.
• If toxicity is suspected, hold the medication first, then notify the provider with focused data.
• Monitor rhythm, heart rate, blood pressure, potassium, renal function, and possible serum digoxin level.

• What you’d do on shift: Check the apical pulse before giving digoxin.
• Review the latest potassium and creatinine before administration if available.
• Ask about nausea, appetite, fatigue, and vision changes.
• Hold the dose for concerning findings and report them promptly.
• Place the client on closer cardiac monitoring if indicated.

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 information would help you decide whether to administer or hold the dose?

2. A client on furosemide and digoxin develops new premature ventricular contractions. Which lab value would you want to review first, and why?

Category for today: Pharmacology

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