NCLEX Question of the Day – Sunday, April 05, 2026

Today’s question targets priority nursing action in a medication safety situation. This matters in real practice because nurses often see the first signs that a drug is harming a patient. Knowing what to do first can prevent a small problem from becoming an emergency. Today’s case focuses on pharmacology and asks you to connect an assessment finding to the safest next step.

Clinical Scenario

A 79-year-old client is admitted to a medical unit with worsening heart failure. The client has a history of atrial fibrillation, chronic kidney disease, and hypertension. Morning medications include furosemide, lisinopril, and digoxin. During the assessment, the nurse notes that the client says, “My stomach feels off, and food tastes strange today.” The client also reports seeing “yellow halos” around the room light. The apical pulse is 52/min and irregular. Blood pressure is 108/64 mm Hg. Potassium from the morning lab draw is 3.1 mEq/L.

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 dose and notify the provider of the findings
3. Give the furosemide first to reduce cardiac workload
4. Offer the client a snack to reduce nausea before medications

Correct Answer

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

Detailed Rationale

This client shows several classic signs of possible digoxin toxicity: nausea, visual changes, and bradycardia. The low potassium level matters because hypokalemia increases the effect of digoxin on the heart. In simple terms, when potassium is low, digoxin can bind more strongly and cause dangerous cardiac effects. That is why this combination of symptoms should get the nurse’s attention right away.

The first nursing action is to hold the digoxin. Giving it would increase the risk of worsening bradycardia, conduction problems, and dysrhythmias. A heart rate of 52/min is already below the usual hold parameter for digoxin in adults. The irregular rhythm adds more concern because this client already has atrial fibrillation and may be more vulnerable to rhythm changes.

After holding the dose, the nurse should notify the provider and report the full picture clearly: apical pulse 52/min and irregular, nausea, yellow halos, potassium 3.1 mEq/L, history of kidney disease, and current digoxin use. Kidney disease is important because digoxin is cleared by the kidneys. Reduced kidney function can let the drug build up in the body, even when the prescribed dose seems routine.

The nurse should also be ready to assess and monitor closely. That includes checking the apical pulse again, reviewing kidney function labs if available, monitoring telemetry if ordered or already in place, and watching for worsening symptoms such as vomiting, confusion, increasing bradycardia, or new dysrhythmias. The provider may order a serum digoxin level, repeat electrolytes, potassium replacement, and changes to the medication plan.

On shift, the practical approach is straightforward. Stop before giving the drug. Confirm the assessment. Connect the symptoms to the medication. Then escalate quickly with a focused report. This is safe nursing judgment because the immediate risk is cardiac instability, not simple stomach upset.

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 signs that suggest digoxin toxicity, and the pulse is low. Rechecking later does not remove the immediate risk of giving a medication that may worsen the problem. The nurse should not give a dose first and hope the client tolerates it.

C. Give the furosemide first to reduce cardiac workload

This is also unsafe. Furosemide can lower potassium further, which can make digoxin toxicity worse. In this scenario, the potassium is already 3.1 mEq/L. The nurse needs to recognize that the electrolyte abnormality is part of the danger, not something to ignore while focusing on heart failure alone.

D. Offer the client a snack to reduce nausea before medications

This addresses comfort, not the priority problem. Nausea here is not just a minor side effect. It is a clue that the medication may be causing harm. Giving food could delay the proper intervention and distract from the bigger issue, which is possible toxicity with cardiac effects.

Key Takeaways

• Digoxin toxicity can show up as nausea, appetite changes, visual disturbances, bradycardia, and dysrhythmias.
• Low potassium increases the risk of digoxin toxicity. Always connect electrolyte results to medication safety.
• In an adult, a low apical pulse is a reason to stop and reassess before giving digoxin.
• Kidney dysfunction raises the risk for digoxin buildup because the drug is cleared renally.
• Priority action: hold the medication, assess carefully, and notify the provider with specific findings.

• What you’d do on shift: check the apical pulse for 1 full minute, review potassium and kidney labs, hold digoxin if findings are concerning, monitor rhythm and symptoms, and call the provider with a focused report.

Quick Practice Extension

1. A client taking digoxin has a potassium level of 5.8 mEq/L and new muscle weakness. What additional assessment finding would most concern you?
2. A client with heart failure asks why the nurse checks the pulse before giving digoxin every day. How would you explain it in clear patient-friendly language?

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