NCLEX Question of the Day

Today’s question targets priority-setting in medication safety, a skill nurses use every shift. The NCLEX often tests whether you can spot the one finding that changes what you do next. In real practice, this matters because acting on the wrong symptom can delay treatment, while recognizing a dangerous adverse effect early can prevent serious harm.

Clinical Scenario

A 68-year-old client is admitted to a medical-surgical unit with community-acquired pneumonia. The client has a history of chronic heart failure, atrial fibrillation, and hypertension. Home medications include digoxin, furosemide, and lisinopril. On the second hospital day, the client tells the nurse, “I feel sick to my stomach, and the lights look strange around them.” The nurse reviews the morning assessment findings: apical pulse 54/min, blood pressure 118/70 mm Hg, oxygen saturation 95% on 2 L nasal cannula, potassium level 3.1 mEq/L, and urine output 900 mL over the last 12 hours. The scheduled morning medications are ready to be given.

The Question

Which action should the nurse take first?

Answer Choices

1. A. Administer the prescribed digoxin and reassess the client in 1 hour
2. B. Hold the digoxin and notify the provider of the client’s findings
3. C. Give the furosemide first to reduce cardiac workload
4. D. Encourage oral fluids and document the visual changes

Correct Answer

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

Detailed Rationale

This client is showing several classic signs that point to possible digoxin toxicity. The most important clues are nausea, visual disturbances, bradycardia, and hypokalemia. When these findings appear together in a client taking digoxin, the nurse should think safety first and stop before giving the medication.

Start with the pulse. Digoxin slows conduction through the heart and can lower the heart rate. An apical pulse of 54/min is already below the usual hold parameter used in many settings. Even if a specific facility policy varies, this low pulse should make the nurse pause and assess further before administration.

Next, look at the symptoms. Nausea is an early and common sign of digoxin toxicity. Visual changes, especially reports that lights look strange, blurred vision, or color changes, are also well-known warning signs. These are not minor side effects to simply chart and watch. They suggest the medication may already be affecting the client too strongly.

The potassium level matters because low potassium makes digoxin more dangerous. Digoxin and potassium compete at the cellular level. When potassium is low, digoxin can bind more easily and produce stronger toxic effects. This client takes furosemide, a loop diuretic that can lower potassium. That history supports the concern even more.

The nurse’s first action is to hold the digoxin. Then notify the provider with a focused report: the client’s symptoms, apical pulse, potassium level, and current medications. The provider may order a digoxin level, repeat electrolytes, potassium replacement, telemetry review, or changes to the medication plan.

After holding the drug and notifying the provider, the nurse should continue targeted assessment and monitoring. That includes checking the heart rhythm, reassessing vital signs, asking more about the visual symptoms, monitoring for vomiting, confusion, weakness, or worsening bradycardia, and reviewing lab trends. If the client becomes unstable, the nurse should escalate care quickly.

This question is really about linking assessment findings to medication safety. The nurse is not just reacting to one symptom. The nurse is putting the whole picture together and recognizing that giving the next dose could worsen a toxic state.

Why the Other Options Are Wrong

A. Administer the prescribed digoxin and reassess the client in 1 hour

This is unsafe. The client already has red flags for toxicity. Reassessing later is not enough when the current findings suggest the drug should be withheld now. Giving digoxin could worsen bradycardia or trigger more serious dysrhythmias.

C. Give the furosemide first to reduce cardiac workload

This ignores the most urgent problem. Furosemide can lower potassium further, which may increase the risk of digoxin toxicity. Even though heart failure management is important, this client’s immediate risk is medication-related harm.

D. Encourage oral fluids and document the visual changes

Documentation is necessary, but it is never the first or only response to a potentially dangerous assessment finding. Encouraging fluids also does not address the likely cause of the symptoms and may not even be appropriate depending on the client’s heart failure status.

Key Takeaways

• Digoxin toxicity can show up as nausea, vomiting, visual changes, weakness, confusion, bradycardia, and dysrhythmias.
• Low potassium increases the risk of digoxin toxicity, especially in clients taking loop diuretics like furosemide.
• Before giving digoxin, assess the apical pulse and review recent electrolyte results when available.
• If toxicity is suspected, hold the medication first, then notify the provider with clear assessment data.

• On-shift mini-checklist:
• Check the apical pulse before digoxin.
• Ask about nausea, appetite, vision changes, and weakness.
• Review potassium and kidney-related labs.
• Hold the dose if findings are concerning.
• Report the full picture, not just one abnormal number.
• Monitor rhythm, symptoms, and response to new orders.

Quick Practice Extension

1. A client taking digoxin has an apical pulse of 62/min, no nausea, and a potassium level of 4.2 mEq/L. What additional assessment would best help the nurse decide whether the medication is safe to give?

2. A client on digoxin and furosemide reports new weakness and poor appetite. Which lab value would concern the nurse most, and why?

Category used today: Pharmacology. This type of question is common because safe medication administration depends on more than following the MAR. The best nurses catch patterns early, and that is exactly what this question tests.

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