NCLEX Question of the Day – Tuesday, March 17, 2026

Today’s question focuses on Pharmacology, specifically safe medication administration when a patient shows early signs of digoxin toxicity. This matters in real nursing because the first clue is often not dramatic. A nurse may notice a slow pulse, new nausea, or a lab value that changes the risk picture. Catching that pattern early can prevent a serious dysrhythmia.

Clinical Scenario

A 79-year-old patient is admitted to a medical-surgical unit with worsening heart failure and mild fluid overload. The patient has a history of atrial fibrillation, chronic heart failure, and hypertension. Morning medications include digoxin 0.125 mg by mouth daily, furosemide 40 mg by mouth daily, and lisinopril 10 mg by mouth daily.

At 0900, the nurse prepares to give scheduled medications. The patient says, “I feel a little sick to my stomach today,” and reports eating very little breakfast. Assessment findings are: apical pulse 54/min and regular, blood pressure 118/68 mm Hg, respirations 18/min, oxygen saturation 96% on room air. The patient is alert and oriented but says, “The lights seem a little strange, kind of yellowish.” Morning lab results show potassium 3.1 mEq/L, creatinine 1.0 mg/dL, and magnesium 1.9 mg/dL.

The Question

What is the nurse’s priority action?

Answer Choices

1. Administer the digoxin as prescribed and reassess the heart rate in 1 hour.
2. Hold the digoxin dose and notify the provider of the patient’s symptoms, pulse, and potassium level.
3. Give the furosemide first to reduce fluid overload, then administer digoxin after lunch.
4. Document the findings as expected for older adults taking cardiac medications.

Correct Answer

B. Hold the digoxin dose and notify the provider of the patient’s symptoms, pulse, and potassium level.

Detailed Rationale

This patient has several findings that point to possible digoxin toxicity or at least a high risk for it. The nurse should recognize the pattern, not treat each sign as unrelated.

First, the apical pulse is 54/min. Digoxin slows conduction through the AV node. A low pulse can mean the drug is having too much effect. In general, the nurse should check the apical pulse before giving digoxin and question the dose if the rate is low, especially below the ordered parameter or commonly below 60/min in adults.

Second, the patient has nausea and reports yellowish vision changes. These are classic warning signs. Digoxin toxicity often shows up first with gastrointestinal and visual symptoms before a major rhythm problem appears.

Third, the potassium is 3.1 mEq/L, which is low. This is a key safety detail. Low potassium increases the effect of digoxin on the heart and raises the risk of toxicity. The patient is also taking furosemide, a loop diuretic that can lower potassium. That combination matters because it explains why this patient is vulnerable right now.

The priority action is to hold the digoxin. Giving it would increase risk. The nurse should then notify the provider and report the full picture: bradycardia, nausea, visual changes, current potassium level, and the fact that the patient also receives furosemide.

After that, the nurse should continue with focused assessment and monitoring. This includes checking for additional signs of toxicity, reviewing the most recent digoxin level if one exists, placing the patient on cardiac monitoring if indicated by unit protocol or condition, and watching for worsening bradycardia or dysrhythmias. The nurse should also expect follow-up orders, such as repeat electrolytes, potassium replacement, holding future doses, or obtaining a digoxin level.

One more point matters: the creatinine is normal here, so kidney failure is not the clearest trigger in this case. That helps the nurse narrow the problem. The strongest risk factor today is hypokalemia combined with symptoms and bradycardia.

Why the Other Options Are Wrong

A. Administer the digoxin as prescribed and reassess the heart rate in 1 hour.

This is unsafe. The nurse already has enough evidence to stop and reassess before administration. A low apical pulse, nausea, and visual changes are not mild findings to “watch later.” Giving the medication could worsen bradycardia or trigger a more serious rhythm disturbance.

C. Give the furosemide first to reduce fluid overload, then administer digoxin after lunch.

This is also unsafe. Furosemide may lower potassium even more, which can increase digoxin toxicity risk. The patient’s fluid status matters, but immediate medication safety comes first. The nurse should not move ahead with either medication without addressing the low potassium and possible toxicity concern.

D. Document the findings as expected for older adults taking cardiac medications.

Age does not make these findings normal. Older adults may be more sensitive to medications, but that means the nurse should be more cautious, not dismissive. Yellow vision changes, nausea, and bradycardia in a patient taking digoxin require action.

Key Takeaways

• Always check the apical pulse before giving digoxin.
• Hold digoxin and question the dose if the patient has bradycardia or symptoms of toxicity.
• Early digoxin toxicity can show up as nausea, poor appetite, fatigue, confusion, or visual changes.
• Low potassium increases digoxin’s effects and raises the risk of dangerous dysrhythmias.
• Loop diuretics like furosemide can contribute to hypokalemia, so look at the medication combination, not just one drug.

• On-shift mini-checklist: check apical pulse, review potassium and renal function, ask about nausea and vision changes, hold digoxin if concerning signs are present, notify the provider, and monitor rhythm and symptoms closely.

Quick Practice Extension

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

2. A patient on digoxin and a loop diuretic develops new confusion and irregular heart rhythm. What labs and assessments would you want to review first, and why?

Questions like this test more than drug facts. They test whether you can connect assessment findings, lab values, and medication risk in real time. That is exactly what safe nursing looks like at the bedside.

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