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

Today’s NCLEX question targets priority action in medication safety, a core Pharmacology skill. This matters in real nursing because a patient can decline quickly from a drug-related problem, and the nurse often notices the first warning sign. Knowing what to assess first, what to hold, and who to notify can prevent serious harm.

Clinical Scenario

A 72-year-old patient is admitted to a medical-surgical unit with heart failure exacerbation and atrial fibrillation. The patient has a history of chronic kidney disease stage 3, hypertension, and poor appetite for the past week. Morning medications include furosemide, lisinopril, and digoxin. During assessment, the nurse notes the patient is more fatigued than yesterday and reports nausea and seeing “yellow-green halos” around the room light. The apical pulse is 54/min and irregular. The most recent lab results show potassium 3.1 mEq/L and creatinine 1.9 mg/dL.

The Question

What is the nurse’s priority action?

Answer Choices

1. A. Administer the digoxin as scheduled and recheck the heart rate in 1 hour
2. B. Hold the digoxin dose and notify the provider of the assessment findings
3. C. Give the furosemide first to reduce cardiac workload and then reassess the patient
4. D. Encourage the patient to eat a potassium-rich breakfast before giving medications

Correct Answer

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

Detailed Rationale

This patient is showing several classic signs of possible digoxin toxicity: nausea, visual changes, bradycardia, and fatigue. 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 toxicity and dangerous dysrhythmias. The reduced kidney function also matters because digoxin is cleared through the kidneys. If the kidneys are not working well, the drug can build up in the body.

The nurse’s first job is to recognize that this is not just a “side effect” to watch later. It is a patient safety issue that needs action now. The correct response is to hold the digoxin. Giving it would increase the risk of worsening bradycardia and rhythm problems. After holding the medication, the nurse should promptly notify the provider and report the key findings clearly: apical pulse 54/min and irregular, nausea, visual halos, potassium 3.1 mEq/L, and creatinine 1.9 mg/dL.

The nurse should also continue focused assessment. That includes checking the patient’s mental status, blood pressure, oxygenation, and current rhythm if telemetry is available. The nurse should review whether a digoxin level has been drawn recently and anticipate new orders. These may include a serum digoxin level, repeat electrolytes, potassium replacement, and ECG monitoring. If the patient becomes unstable, such as having severe bradycardia, hypotension, chest pain, or worsening dysrhythmias, the nurse would escalate care immediately.

This question is really about pattern recognition and priority. One abnormal finding alone might not be enough. But together, the symptoms, low heart rate, hypokalemia, and kidney impairment point strongly toward toxicity risk. On the NCLEX, when a medication could harm the patient right now, the safest answer is usually to hold the drug and report the findings.

Why the Other Options Are Wrong

A. Administer the digoxin as scheduled and recheck the heart rate in 1 hour

This is unsafe. A heart rate of 54/min is already below the usual parameter for giving digoxin in adults. More important, the patient also has symptoms that suggest toxicity. Waiting an hour after giving the drug could allow the condition to worsen.

C. Give the furosemide first to reduce cardiac workload and then reassess the patient

This is not the priority. Furosemide can lower potassium even more, which may increase the toxic effects of digoxin. The nurse should not move ahead with a plan that may intensify the problem before addressing the immediate safety concern.

D. Encourage the patient to eat a potassium-rich breakfast before giving medications

This sounds helpful, but it is too slow and too limited for the current situation. Food will not correct symptomatic possible digoxin toxicity fast enough. Also, the patient already has warning signs that require holding the dose and contacting the provider, not simply giving dietary advice.

Key Takeaways

• Digoxin toxicity can show up as nausea, vomiting, fatigue, confusion, visual changes, bradycardia, and dysrhythmias.
• Low potassium increases the risk because it makes digoxin act more strongly at the cardiac cell.
• Reduced kidney function raises the risk of drug buildup because digoxin is renally cleared.
• If the apical pulse is low and toxicity is suspected, hold the dose and notify the provider.
• Always connect symptoms, vital signs, labs, and medication profile instead of looking at each one alone.

• On-shift mini-checklist:
• Check the apical pulse before giving digoxin.
• Review potassium and renal function before administration if results are available.
• Ask about nausea, appetite, new fatigue, and visual changes.
• Hold the medication if findings are concerning.
• Report the full picture clearly and monitor rhythm and hemodynamic status.

Quick Practice Extension

1. A patient taking digoxin has an apical pulse of 62/min, no symptoms, potassium 4.2 mEq/L, and normal creatinine. What assessment finding would make you question giving the dose anyway?

2. A patient on digoxin and a loop diuretic develops new confusion and palpitations. Which lab values and monitoring data would you review first, and why?

Category today: Pharmacology

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