NCLEX Question of the Day – Sunday, March 22, 2026

Today’s question targets prioritization in pharmacology, especially spotting a dangerous medication effect before it becomes an emergency. This matters in real nursing because many serious drug reactions start with subtle changes. A nurse who recognizes the pattern early can prevent respiratory failure, cardiac instability, or a rapid decline.

Clinical Scenario

A 72-year-old client is on a medical-surgical unit after being admitted with new-onset atrial fibrillation with rapid ventricular response. The provider prescribed digoxin 0.125 mg by mouth daily to help control the ventricular rate. The client also takes furosemide for heart failure and has had poor appetite for two days.

At 0800, the nurse prepares to give the scheduled morning medications. The client is awake, reports feeling “queasy,” and says breakfast “tastes strange.” Assessment findings are: apical pulse 54/min and regular, blood pressure 108/64 mm Hg, respiratory rate 18/min, oxygen saturation 96% on room air. The telemetry monitor shows sinus bradycardia. Morning lab results show potassium 3.1 mEq/L.

The Question

What is the nurse’s best action at this time?

Answer Choices

1. A. Administer the digoxin as prescribed and recheck the apical pulse in 1 hour
2. B. Hold the digoxin dose and notify the provider of the client’s heart rate, symptoms, and potassium level
3. C. Give the furosemide first, then administer digoxin after the client eats breakfast
4. D. Ask the client to ambulate in the hallway to improve cardiac output before giving the medication

Correct Answer

B. Hold the digoxin dose and notify the provider of the client’s heart rate, symptoms, and potassium level

Detailed Rationale

This client is showing several signs that point to possible digoxin toxicity or high risk for toxicity. The nurse should recognize the pattern, not just one abnormal number.

First, the apical pulse is 54/min. Digoxin slows conduction through the AV node. That can be useful in atrial fibrillation, but if the rate is already too low, giving the drug can worsen bradycardia and reduce cardiac output. In general, the nurse should hold digoxin and clarify the order if the apical heart rate is below the facility’s hold parameter, commonly under 60/min in adults.

Second, the client reports nausea and altered taste. Early digoxin toxicity often starts with gastrointestinal or vague neurologic symptoms. Nurses sometimes expect dramatic findings first, but toxicity can begin with subtle complaints such as poor appetite, nausea, weakness, or visual changes.

Third, the potassium is 3.1 mEq/L, which is low. This is a key safety clue. Low potassium increases the effects of digoxin at the cellular level, which raises the risk of toxicity even when the digoxin dose looks standard. The client also takes furosemide, a loop diuretic that can cause potassium loss. That combination makes the situation more concerning.

The nurse’s best action is to hold the digoxin, assess fully, and notify the provider with the important data: heart rate, rhythm, symptoms, potassium level, and current medications. The provider may order a digoxin level, potassium replacement, telemetry review, or changes to the medication plan.

What should the nurse assess and monitor next?

• Apical pulse for a full minute before any future digoxin dose
• Cardiac rhythm for worsening bradycardia or conduction changes
• Electrolytes, especially potassium and possibly magnesium
• Signs of worsening toxicity such as vomiting, confusion, weakness, or visual disturbances
• Renal function, because impaired clearance can increase digoxin levels

What should the nurse do right now on shift? Hold the dose, keep the client safe, report the findings clearly, and prepare to carry out new orders. The goal is to prevent a low-rate rhythm from becoming unstable and to correct the electrolyte problem that may be driving the risk.

Why the Other Options Are Wrong

A. Administer the digoxin as prescribed and recheck the apical pulse in 1 hour

This is unsafe. The client already has bradycardia and symptoms that fit possible toxicity. Waiting an hour after giving the dose could allow the heart rate to drop further. The nurse should not give a rate-slowing medication when clear warning signs are present.

C. Give the furosemide first, then administer digoxin after the client eats breakfast

This makes the problem worse. Furosemide can lower potassium even more. In this client, potassium is already low, which increases digoxin toxicity risk. Food does not fix bradycardia or hypokalemia. The issue is not an empty stomach. The issue is an unsafe medication situation.

D. Ask the client to ambulate in the hallway to improve cardiac output before giving the medication

This is not appropriate. Ambulation does not correct digoxin-related bradycardia or low potassium. It may also increase fall risk in a client who is symptomatic and bradycardic. The nurse should keep the client safe and assess, not add activity.

Key Takeaways

• Digoxin should be used carefully when the heart rate is low. Always check the apical pulse before giving it.
• Low potassium makes digoxin more dangerous because it increases the drug’s effect on the heart.
• Early digoxin toxicity may show up as nausea, poor appetite, weakness, or visual changes, not just severe arrhythmias.
• Loop diuretics such as furosemide can raise toxicity risk by causing potassium loss.
• The safest nursing action is often to hold the medication first when assessment data show possible harm.

What you’d do on shift:

• Check apical pulse for 1 full minute before digoxin
• Review potassium and renal function before giving the dose
• Ask about nausea, appetite, vision changes, and weakness
• Hold digoxin if the rate is below parameters or toxicity is suspected
• Notify the provider with focused, relevant data
• Monitor telemetry and be ready for new orders

Quick Practice Extension

1. A client receiving digoxin has a potassium level of 4.2 mEq/L and an apical pulse of 62/min, but reports yellow halos around lights. What should the nurse consider first?

2. A client on digoxin and a loop diuretic develops vomiting and new confusion. Which assessment findings would make the situation more urgent to report immediately?

Category for today: Pharmacology

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