NCLEX Question of the Day – Sunday, April 26, 2026

Today’s question targets early recognition of a medication-related emergency and the nurse’s first priority response. This matters because safe nursing is not just about knowing side effects. It is about spotting the one finding that signals immediate harm, then acting in the right order. In real practice, this can prevent a patient from deteriorating fast.

Clinical Scenario

A 72-year-old man is admitted to a medical-surgical unit with community-acquired pneumonia. His history includes chronic atrial fibrillation, heart failure, and stage 3 chronic kidney disease. He has been taking digoxin daily at home for rate control. This morning, the nurse reviews new laboratory results: potassium 3.0 mEq/L, creatinine 1.9 mg/dL, and digoxin level 2.4 ng/mL. During assessment, the patient says, “I feel sick to my stomach, and the lights look kind of yellow.” His apical pulse is 52/min and irregular. He is awake, oriented, and his blood pressure is 108/64 mm Hg.

The Question

Which action should the nurse take first?

Answer Choices

1. A. Administer the scheduled digoxin dose with food to reduce nausea
2. B. Notify the provider and hold the digoxin dose
3. C. Place the patient flat in bed and encourage oral fluids
4. D. Document the findings as expected effects of atrial fibrillation

Correct Answer

B. Notify the provider and hold the digoxin dose

Detailed Rationale

This patient has several findings that strongly point to digoxin toxicity: nausea, yellow visual changes, bradycardia, an irregular pulse, and an elevated digoxin level. The low potassium matters too. Hypokalemia increases the risk of digoxin toxicity because potassium and digoxin compete at the cellular level. When potassium is low, digoxin has a stronger effect, which can trigger dangerous dysrhythmias.

The nurse’s first action is to hold the digoxin and notify the provider. Why first? Because giving another dose could worsen toxicity. The patient already shows both classic symptoms and objective evidence that the drug is causing harm.

After holding the medication and contacting the provider, the nurse should continue with focused assessment and monitoring. That includes:

• Reassessing apical heart rate and rhythm carefully
• Placing the patient on cardiac monitoring if not already on telemetry
• Reviewing electrolyte results, especially potassium and magnesium
• Monitoring for worsening symptoms such as vomiting, confusion, severe bradycardia, or new dysrhythmias
• Preparing for possible new orders, such as potassium replacement, repeat digoxin level, ECG, or treatment for serious toxicity

The nurse should also think through the bigger picture. This patient is older and has chronic kidney disease. Digoxin is cleared mainly by the kidneys, so reduced renal function raises the risk of drug accumulation. That is why this history is important. The problem is not just today’s heart rate. It is the combination of age, kidney impairment, low potassium, symptoms, and a high serum level.

In practice, this is a good example of priority thinking. The nurse does not need to wait until the patient becomes unstable. The warning signs are already present. Recognizing them early is what protects the patient.

Why the Other Options Are Wrong

A. Administer the scheduled digoxin dose with food to reduce nausea

This is unsafe. Food might reduce mild stomach upset in some situations, but nausea here is not a simple minor side effect. It is a warning sign of toxicity. Giving the dose would add to the problem and could worsen bradycardia or trigger a more serious rhythm disturbance.

C. Place the patient flat in bed and encourage oral fluids

This does not address the cause of the problem. The patient is not showing signs of dehydration as the main issue. Encouraging fluids also does nothing to stop the toxic medication effect. In some patients with heart failure, aggressive fluids may not even be appropriate. The priority is to stop further exposure to digoxin and escalate care.

D. Document the findings as expected effects of atrial fibrillation

This is incorrect because the findings are not adequately explained by atrial fibrillation alone. Atrial fibrillation can cause an irregular rhythm, but it does not explain yellow vision, nausea, a digoxin level of 2.4 ng/mL, and a potassium of 3.0 mEq/L. Normalizing these findings would delay treatment and increase risk.

Key Takeaways

• Digoxin toxicity often shows up as nausea, vomiting, visual changes, confusion, and bradycardia.
• Low potassium increases the risk of digoxin toxicity.
• Older adults and patients with kidney disease are at higher risk because digoxin can build up.
• If toxicity is suspected, hold the dose first and notify the provider promptly.
• Do not dismiss new symptoms as “expected” when the full clinical picture suggests a medication emergency.

• What you’d do on shift:
• Check the apical pulse before giving digoxin.
• Review potassium, creatinine, and digoxin level if available.
• Ask about nausea, appetite, vision changes, and dizziness.
• Hold the medication if toxicity is suspected or the heart rate is too low per facility policy or order parameters.
• Notify the provider and monitor cardiac status closely.

Quick Practice Extension

1. A patient taking digoxin develops new confusion and frequent premature ventricular beats after several days of diarrhea. Which lab value would you want to review first?

2. A nurse is teaching a patient newly prescribed digoxin at home. Which symptom should the patient report right away?

Category today: Pharmacology

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