NCLEX Question of the Day – Wednesday, July 01, 2026

Today’s question focuses on early recognition of medication-related complications, a skill that matters on every shift. Nurses often see the first warning signs before a lab value or provider note confirms the problem. Catching the pattern early helps prevent harm and guides the right next step.

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 stage 3. Morning medications include furosemide, lisinopril, and digoxin. During assessment, the nurse notes the client reports nausea, poor appetite, and seeing “yellow halos” around the room light. The apical pulse is 52/min and irregular. Morning lab results show potassium 3.1 mEq/L and creatinine slightly higher than the client’s baseline.

The Question

Which action should the nurse take first?

Answer Choices

1. A. Administer the scheduled digoxin and reassess the pulse in 1 hour
2. B. Hold the digoxin dose and notify the provider of the findings
3. C. Give the furosemide first to improve cardiac workload and reduce symptoms
4. D. Encourage oral fluids and document the visual changes as a likely age-related finding

Correct Answer

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

Detailed Rationale

This client has several classic signs that point to possible digoxin toxicity. The nurse should recognize the pattern, stop the next dose, and escalate promptly.

Start with the assessment clues:

• Apical pulse of 52/min: Digoxin slows conduction through the heart. A low pulse is a major warning sign.
• Nausea and poor appetite: These are common early toxicity symptoms.
• Yellow halos: Visual disturbances are strongly associated with digoxin toxicity.
• Potassium 3.1 mEq/L: Low potassium increases the heart’s sensitivity to digoxin, which raises toxicity risk even when the dose is routine.
• Chronic kidney disease and rising creatinine: Digoxin is cleared by the kidneys. Reduced kidney function can cause the drug to build up.

The nurse’s first priority is safety. That means not giving a medication that may worsen bradycardia or trigger dangerous dysrhythmias. Holding the digoxin prevents further exposure while the provider evaluates the client. The provider may order a serum digoxin level, repeat electrolytes, an ECG, potassium replacement, or changes to the medication plan.

What should the nurse assess right away?

• Apical pulse for a full minute
• Cardiac rhythm and any palpitations, dizziness, or syncope
• Severity of nausea, vomiting, confusion, or vision changes
• Latest potassium and kidney function results
• Recent medication history, especially diuretics that can lower potassium

What should the nurse do after holding the dose and notifying the provider?

• Place the client on closer cardiac monitoring if available or increase frequency of rhythm checks
• Anticipate orders for potassium replacement because hypokalemia increases toxicity risk
• Monitor for worsening bradycardia, new ectopy, or changes in mental status
• Review intake and output, since fluid shifts and renal function affect medication safety

Why this matters in real nursing: digoxin toxicity can begin with subtle symptoms that are easy to dismiss, especially in older adults. A client may first mention appetite changes or strange vision before a severe arrhythmia occurs. The nurse’s job is to connect those clues and act before the situation escalates.

Why the Other Options Are Wrong

A. Administer the scheduled digoxin and reassess the pulse in 1 hour

This is unsafe. The client already has multiple signs of toxicity, including bradycardia, visual changes, nausea, hypokalemia, and reduced renal clearance. Giving the drug could worsen conduction problems and increase the risk of serious arrhythmias.

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

This choice misses the immediate problem. Furosemide can lower potassium further, which may make digoxin toxicity worse. The client’s potassium is already 3.1 mEq/L. Even if the client needs diuresis, the toxicity concern comes first.

D. Encourage oral fluids and document the visual changes as a likely age-related finding

This minimizes a dangerous symptom. Yellow halos are not something the nurse should brush off as normal aging. Also, fluid advice should be individualized in heart failure and kidney disease, not given casually. The key issue here is medication toxicity, not simple dehydration.

Key Takeaways

• Digoxin toxicity often shows up as nausea, poor appetite, visual changes, and bradycardia.
• Low potassium makes digoxin more dangerous because it increases the drug’s effect on the heart.
• Kidney impairment raises toxicity risk because digoxin is cleared renally.
• If toxicity is suspected, hold the dose first, then notify the provider.
• Always assess the apical pulse for a full minute before giving digoxin.

• What you’d do on shift:
• Check the apical pulse before administration.
• Review potassium and creatinine before giving the dose.
• Ask about nausea, appetite, and vision changes.
• Hold digoxin if the pulse is low or toxicity is suspected.
• Notify the provider and monitor rhythm closely.

Quick Practice Extension

1. A client taking digoxin has an apical pulse of 58/min but denies symptoms. What additional data would help you decide the safest next step?

2. A client on digoxin and a loop diuretic develops frequent premature ventricular contractions. Which electrolyte problem would you suspect first, and why?

Category today: Pharmacology

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