NCLEX Question of the Day

Today’s NCLEX question focuses on priority action in Pharmacology. This skill matters because medication problems can turn serious fast, and nurses are often the first to spot early warning signs. The real job is not just knowing a drug name. It is knowing what to assess first, what to hold, and when a finding points to possible toxicity instead of a routine side effect.

Clinical Scenario

A 79-year-old client is admitted to a medical unit with worsening heart failure. The client has a history of atrial fibrillation, chronic kidney disease, and hypertension. Morning medications include digoxin, furosemide, lisinopril, and potassium chloride.

Before giving the 0900 medications, the nurse reviews the latest findings. The client reports poor appetite, mild nausea, and seeing “yellow halos” around the room lights. The apical pulse is 54/min and irregular. Potassium level is 3.1 mEq/L. Creatinine is higher than it was two days ago. The client is awake, calm, and denies chest pain or shortness of breath.

The Question

Which action should the nurse take first?

Answer Choices

1. Administer the digoxin as prescribed and recheck the pulse in 1 hour
2. Hold the digoxin and notify the provider of suspected toxicity
3. Give the furosemide first to reduce fluid overload before reassessing
4. Encourage oral fluids and give the potassium chloride after breakfast

Correct Answer

B. Hold the digoxin and notify the provider of suspected toxicity

Detailed Rationale

This client has several findings that point to digoxin toxicity, and the nurse should act on that concern first. The most important clues are the apical pulse of 54/min, nausea, poor appetite, and yellow halos. That visual change is not a routine harmless complaint. It is a classic toxicity clue.

The nurse should assess the apical pulse before giving digoxin because digoxin slows conduction through the heart and can worsen bradycardia. In many adult clients, the medication is held if the apical pulse is below 60/min, depending on the order and facility policy. Here, the pulse is not just low. It is also irregular, which adds concern in a client with atrial fibrillation.

The potassium level also matters. A potassium of 3.1 mEq/L is low. Low potassium increases the effects of digoxin on the myocardium and raises the risk for toxicity and dangerous dysrhythmias. In simple terms, when potassium is low, digoxin can bind more easily and act more strongly. That is why hypokalemia and digoxin are a risky combination.

The rising creatinine is another key detail. Digoxin is cleared through the kidneys. When kidney function worsens, the drug can build up in the body. Older adults are at even higher risk because they often have reduced renal clearance and may show toxicity with smaller changes in dose or kidney function.

The first nursing action is to hold the dose. Then the nurse should notify the provider and report the specific findings: pulse 54 and irregular, nausea, poor appetite, yellow halos, potassium 3.1, and worsening renal function. The nurse should also anticipate further steps such as a serum digoxin level, repeat electrolyte checks, continuous cardiac monitoring, and possible adjustments to the medication plan.

On shift, this means the nurse does more than just skip one pill. The nurse should continue focused assessment and monitoring. Check for worsening bradycardia, new dysrhythmias, vomiting, confusion, weakness, or dizziness. Review the medication list for anything that may add risk, such as diuretics causing potassium loss. Document clearly why the medication was held and whom you notified.

Why the Other Options Are Wrong

A. Administer the digoxin as prescribed and recheck the pulse in 1 hour

This is unsafe. The client already shows signs of possible toxicity. Giving digoxin now could worsen bradycardia or trigger serious rhythm problems. Rechecking later is too late when the warning signs are already present.

C. Give the furosemide first to reduce fluid overload before reassessing

This does not address the immediate safety issue. In fact, furosemide can lower potassium further, which may increase digoxin toxicity risk. Even if the client has heart failure, the priority right now is the suspected medication toxicity.

D. Encourage oral fluids and give the potassium chloride after breakfast

Potassium replacement may be needed, but this is not the first step in the answer set because the unsafe medication must be held immediately. Also, encouraging fluids is not automatically appropriate in a client with heart failure, where fluid balance must be managed carefully. The nurse should not delay provider notification while trying to correct the problem independently.

Key Takeaways

• Digoxin toxicity often shows up as nausea, poor appetite, visual changes, bradycardia, and dysrhythmias.
• Low potassium makes digoxin more dangerous because it increases the drug’s effect on the heart.
• Older adults and clients with kidney disease are at higher risk because digoxin can accumulate.
• Always check the apical pulse before giving digoxin and question a low rate.
• The first move in suspected toxicity is to hold the medication and notify the provider.

• What you’d do on shift: assess apical pulse, review potassium and creatinine, hold digoxin if findings are unsafe, place the client on closer cardiac monitoring if needed, report clear data to the provider, and document the reason the drug was withheld.

Quick Practice Extension

1. A client taking digoxin has an apical pulse of 62/min but reports new vomiting and confusion. What assessment findings would make you most concerned about worsening toxicity?

2. A client on furosemide and digoxin has leg cramps and weakness. Which lab value would you want to review first, and why?

NCLEX Question of the Day – Monday, July 13, 2026

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