NCLEX Question of the Day – Thursday, June 18, 2026

Today’s NCLEX question targets Pharmacology, with a focus on spotting early medication toxicity and acting fast. This matters in real nursing because the first clue is often a small assessment change, not a dramatic emergency. Nurses protect patients by noticing that change, connecting it to the drug, and taking 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. Current prescriptions include digoxin, furosemide, lisinopril, and a low-sodium diet. On the third hospital day, the nurse notes that the client seems more tired than usual and has eaten very little breakfast. The client says, “My stomach feels off, and the lights look strange, kind of yellow-green.”

Morning assessment findings are:

• Apical pulse: 52/min and regular
• Blood pressure: 108/64 mm Hg
• Potassium: 3.1 mEq/L
• Creatinine: 2.0 mg/dL
• Oxygen saturation: 95% on room air

The nurse reviews the medication administration record and sees that digoxin is due now.

The Question

What is the nurse’s priority action?

Answer Choices

1. Administer the digoxin as prescribed and reassess the apical pulse in 1 hour
2. Hold the digoxin dose and notify the provider of suspected digoxin toxicity
3. Give the furosemide first to reduce the client’s cardiac workload
4. Encourage the client to eat and administer digoxin with food to limit stomach upset

Correct Answer

B. Hold the digoxin dose and notify the provider of suspected digoxin toxicity

Detailed Rationale

This client is showing several classic signs that point to digoxin toxicity. The important step is not just recognizing one symptom, but putting the whole picture together.

First, the client has nausea and poor appetite. These are common early signs of digoxin toxicity. Older adults may show these subtle symptoms before more obvious instability appears.

Second, the client reports yellow-green visual changes. Visual disturbances are strongly associated with digoxin toxicity. When a nurse hears a symptom like this in a client taking digoxin, it should raise concern right away.

Third, the client’s apical pulse is 52/min. Digoxin slows conduction through the heart. A low pulse can mean the medication is having too much effect. In practice, digoxin is commonly held if the apical pulse is below the ordered parameter, often 60/min in adults, though the nurse should follow the specific order and agency policy.

Fourth, the client has hypokalemia with a potassium level of 3.1 mEq/L. Low potassium increases the risk of digoxin toxicity because digoxin binds more easily and has a stronger effect when potassium is low. This matters even more because the client is also taking furosemide, a loop diuretic that can lower potassium.

Fifth, the client has chronic kidney disease and a creatinine of 2.0 mg/dL. Digoxin is cleared by the kidneys. Reduced kidney function can lead to drug buildup, especially in older adults.

The nurse’s priority action is to hold the medication and notify the provider. Giving the dose could worsen bradycardia or trigger dangerous dysrhythmias. After holding the dose, the nurse should continue focused assessment and monitoring.

What the nurse should assess, do, and monitor:

• Reassess apical pulse and rhythm carefully for a full minute
• Place the client on cardiac monitoring if available or anticipate an ECG order
• Review recent potassium, magnesium, and renal function results
• Monitor for worsening symptoms such as vomiting, confusion, increasing bradycardia, or new dysrhythmias
• Prepare to report clear, organized data: symptoms, pulse, potassium, creatinine, current medications, and timing of last digoxin dose
• Expect possible orders for a digoxin level, electrolyte replacement, and adjustment or temporary discontinuation of digoxin

The key nursing judgment here is safety. The nurse should not wait for more severe signs before acting. Early recognition can prevent a serious cardiac event.

Why the Other Options Are Wrong

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

This is unsafe. The client already has multiple signs of toxicity, including bradycardia, GI symptoms, visual changes, low potassium, and impaired renal function. Giving digoxin now could worsen the problem. Reassessing later is too late if the medication causes further conduction slowing or dysrhythmias.

C. Give the furosemide first to reduce the client’s cardiac workload

This misses the immediate risk. Furosemide may be useful in heart failure, but it can also worsen potassium loss. In a client with suspected digoxin toxicity and a potassium of 3.1 mEq/L, giving furosemide first could increase toxicity risk. The priority is to stop the possible cause of harm and report it.

D. Encourage the client to eat and administer digoxin with food to limit stomach upset

This assumes the nausea is a minor side effect rather than a warning sign. In this scenario, the stomach upset is part of a larger toxic pattern. Food does not fix digoxin toxicity. The medication should be held, not given.

Key Takeaways

• Digoxin toxicity often starts with subtle findings: nausea, anorexia, fatigue, and visual changes.
• Hypokalemia raises digoxin toxicity risk because it increases digoxin’s effect on the heart.
• Older adults and clients with kidney disease are at higher risk because the drug can accumulate.
• Always check the apical pulse before digoxin and hold the dose if the rate is below the ordered limit.
• The safest priority is to hold the medication and notify the provider when toxicity is suspected.

• On shift mini-checklist: Check apical pulse for 1 full minute, review potassium and creatinine, ask about nausea and vision changes, hold digoxin if concerning signs are present, and report findings promptly.

Quick Practice Extension

1. A client taking digoxin develops new confusion and an irregular pulse. Which assessment finding would make the nurse most concerned that the condition is becoming more serious?

2. A client on digoxin and furosemide has a potassium level of 3.4 mEq/L but no symptoms. What nursing teaching and monitoring would help prevent toxicity before it develops?

NCLEX Question of the Day – Thursday, June 18, 2026

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