NCLEX Question of the Day – Tuesday, May 19, 2026

Today’s NCLEX question targets safe medication administration in a high-risk situation. This matters in real nursing because medication errors often happen during routine care, especially when a patient’s condition changes quickly. A strong nurse does not just give a drug because it is scheduled. The nurse checks the patient first, looks for red flags, and knows when to hold the medication and call the provider.

Clinical Scenario

A 72-year-old client is admitted to a medical-surgical unit with worsening heart failure. The client has a history of atrial fibrillation, hypertension, and chronic kidney disease. Morning medications include digoxin 0.125 mg by mouth daily, furosemide 40 mg IV, and lisinopril 10 mg by mouth. During the 0800 assessment, the nurse notes the client is nauseated, reports seeing “yellow halos” around the lights, and seems more fatigued than yesterday. Vital signs are: temperature 98.4 F, blood pressure 104/62 mm Hg, heart rate 52/min and irregular, respiratory rate 18/min, oxygen saturation 95% on 2 L nasal cannula. The client’s potassium level from this morning is 3.1 mEq/L.

The Question

Which action should the nurse take first?

Answer Choices

1. Administer the scheduled digoxin and recheck the apical pulse in 1 hour.
2. Hold the digoxin dose and notify the provider of the assessment findings.
3. Give the furosemide first to reduce cardiac workload and improve symptoms.
4. Ask the client whether the visual changes have happened before and document the response.

Correct Answer

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

Detailed Rationale

This client is showing several classic signs of possible digoxin toxicity. The most important clues are the heart rate of 52/min, nausea, fatigue, and visual changes described as yellow halos. On top of that, the potassium level is low at 3.1 mEq/L. Low potassium increases the risk of digoxin toxicity because digoxin binds more easily in the setting of hypokalemia. The client also has chronic kidney disease, which matters because digoxin is cleared by the kidneys. Poor kidney function can cause the medication to build up in the body.

The nurse’s first action is to hold the digoxin. A slow pulse is already a major reason to pause and reassess before giving this drug. In many settings, the nurse holds digoxin and contacts the provider if the apical pulse is below the ordered parameter, often 60/min in adults. Here, the client has much more than a borderline pulse. The symptoms strongly suggest toxicity.

After holding the medication, the nurse should notify the provider promptly and report the full picture: irregular heart rate of 52/min, nausea, yellow halos, fatigue, low potassium, kidney disease, and current digoxin order. This helps the provider make safe next-step decisions such as ordering a digoxin level, replacing potassium, obtaining an ECG, adjusting medications, or evaluating for worsening dysrhythmias.

The nurse should also continue focused assessment and monitoring. That includes checking the apical pulse carefully for a full minute, reviewing the medication administration record for recent doses, monitoring cardiac rhythm, watching for worsening bradycardia or ectopy, and reassessing mental status, vision changes, and GI symptoms. The nurse should review lab trends, especially potassium, magnesium, creatinine, and BUN, because electrolyte imbalance and reduced renal clearance can worsen toxicity.

Another key point is that furosemide can make the problem worse in this moment. Loop diuretics increase potassium loss. If this client already has hypokalemia, more diuresis without addressing the potassium and digoxin concern could increase the risk for dangerous rhythm problems. The right priority is to stop the suspected harmful medication, recognize the unstable pattern, and escalate care.

Why the Other Options Are Wrong

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

This is unsafe. The nurse already has enough evidence to suspect digoxin toxicity. Giving the medication would increase the risk of severe bradycardia and dysrhythmias. The nurse should not delay action when clear warning signs are present.

C. Give the furosemide first to reduce cardiac workload and improve symptoms.

This misses the immediate safety issue. Furosemide may be part of the heart failure plan, but this client’s low potassium and probable digoxin toxicity make that dangerous right now. Furosemide can lower potassium further, which may worsen the toxic effects of digoxin.

D. Ask the client whether the visual changes have happened before and document the response.

Assessment questions can be helpful, but this is not the first priority. The nurse already has significant abnormal findings that require action. Documentation matters, but it does not treat or prevent harm. When a medication reaction is suspected, the nurse acts first to protect the client.

Key Takeaways

• Digoxin toxicity can show up as nausea, fatigue, confusion, visual changes, and bradycardia.
• Low potassium increases digoxin toxicity risk because it strengthens digoxin’s effects on the heart.
• Kidney disease raises the risk because digoxin is cleared renally.
• If the client has a slow pulse or toxicity symptoms, hold digoxin and notify the provider.
• Always connect the medication, the lab values, and the current assessment before giving a scheduled drug.

• On-shift mini-checklist:
• Check apical pulse for 1 full minute before digoxin.
• Review potassium, magnesium, and renal function.
• Ask about nausea, appetite, fatigue, and visual changes.
• Hold the dose if findings are unsafe.
• Notify the provider with focused, relevant data.
• Monitor rhythm and prepare for follow-up orders.

Quick Practice Extension

1. A client taking digoxin has an apical pulse of 58/min but no nausea or visual changes. What additional data would most help the nurse decide the safest next step?

2. A client on furosemide and digoxin develops frequent premature ventricular contractions. Which labs and assessment findings should the nurse review first?

Category used today: Med-Surg.

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