NCLEX Question of the Day – Wednesday, June 10, 2026

Today’s NCLEX question targets Pharmacology, with a focus on spotting a high-risk medication problem before harm happens. This matters in real nursing because many medication errors are not dramatic at first. They start with one subtle assessment finding, one abnormal lab value, or one symptom that seems small until it is not.

Clinical Scenario

A 71-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. Current medications include furosemide, lisinopril, and digoxin. On the second hospital day, the nurse notes that the client is more fatigued than usual and says, “Food tastes strange, and I feel a little sick to my stomach.” The client’s apical pulse is 54/min and regular. Morning labs show potassium 3.1 mEq/L and creatinine 1.9 mg/dL.

The Question

Which action should the nurse take first?

Answer Choices

1. Administer the scheduled digoxin and recheck the heart rate in 1 hour.
2. Hold the digoxin dose and notify the provider of the client’s findings.
3. Give an antiemetic for nausea and encourage the client to eat breakfast.
4. Request that the pharmacy send the next dose of furosemide as soon as possible.

Correct Answer

B. Hold the digoxin dose and notify the provider of the client’s findings.

Detailed Rationale

This client is showing signs that strongly suggest digoxin toxicity risk, and the nurse should act before giving the medication. The key clues are not just one finding. It is the pattern.

First, the client has an apical pulse of 54/min. Digoxin slows conduction through the AV node. That can be useful in atrial fibrillation, but too much effect can lead to clinically important bradycardia. Before giving digoxin, the nurse should assess the apical pulse carefully. In many settings, the medication is withheld and the provider is notified if the adult heart rate is below the ordered parameter or commonly below 60/min.

Second, the client reports nausea and altered taste. Early digoxin toxicity often shows up as gastrointestinal symptoms such as nausea, vomiting, and poor appetite. Patients may also describe visual changes or unusual sensory complaints. These symptoms matter because they often appear before severe dysrhythmias develop.

Third, the client has a potassium level of 3.1 mEq/L, which is low. This is a major risk factor. Low potassium makes digoxin more potent at the cellular level, which increases the chance of toxicity even if the dose has not changed. In this case, the furosemide may have contributed to potassium loss.

Fourth, the client has chronic kidney disease and a creatinine of 1.9 mg/dL. Digoxin is cleared by the kidneys. When kidney function is reduced, the drug can build up more easily. That means an older adult with renal impairment is already at higher risk.

Putting all of this together, the safest first action is to hold the digoxin and notify the provider. The nurse should also be ready to monitor the client more closely. That includes reassessing heart rate and rhythm, reviewing any recent digoxin level if available, checking for worsening symptoms, and anticipating orders for potassium replacement, ECG monitoring, or further lab testing.

On shift, this is what the nurse should think through:

• Assess the apical pulse for a full minute.
• Review symptoms that may point to toxicity: nausea, vomiting, fatigue, confusion, visual changes.
• Check potassium and renal function because both affect digoxin safety.
• Hold the medication if the findings are unsafe.
• Report the full picture, not just one number: low pulse, symptoms, low potassium, kidney disease.
• Continue monitoring for dysrhythmias and changes in perfusion.

The reason this action comes first is simple: once the nurse gives the medication, the risk increases. Preventing harm is the priority.

Why the Other Options Are Wrong

A. Administer the scheduled digoxin and recheck the heart rate in 1 hour.

This is unsafe. The client already has bradycardia and multiple toxicity risk factors. Waiting until after administration could allow the heart rate to drop further or trigger more serious conduction problems. Rechecking later does not fix the immediate risk.

C. Give an antiemetic for nausea and encourage the client to eat breakfast.

This treats only one symptom and misses the cause. Nausea in this setting is a warning sign, not just a comfort issue. Covering up the symptom without addressing the possible drug toxicity could delay necessary intervention.

D. Request that the pharmacy send the next dose of furosemide as soon as possible.

This could make the situation worse. Furosemide can lower potassium further. Since hypokalemia increases the effects of digoxin, giving more loop diuretic without addressing the potassium problem could raise toxicity risk even more.

Key Takeaways

• Digoxin toxicity risk rises with low potassium, older age, and impaired kidney function.
• Important warning signs include bradycardia, nausea, poor appetite, fatigue, and visual or sensory changes.
• Before giving digoxin, assess the apical pulse and review recent labs.
• If findings are unsafe, hold the dose and notify the provider.

• What you’d do on shift:
• Check the apical pulse for 1 full minute.
• Ask about nausea, vomiting, vision changes, and weakness.
• Review potassium, creatinine, and any digoxin level.
• Hold digoxin if the heart rate is low or toxicity is suspected.
• Report clearly and continue cardiac monitoring as needed.

Quick Practice Extension

1. A client taking digoxin reports seeing yellow-green halos around lights. What additional assessment finding would most increase your concern for toxicity?

2. A client on furosemide and digoxin has a potassium level of 3.0 mEq/L but no symptoms yet. What nursing actions should you prioritize before the next scheduled digoxin dose?

NCLEX Question of the Day – Wednesday, June 10, 2026

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