# The nurse reviews a follow-up note for a client taking digoxin. Which findings require immediate follow-up before the next dose? Highlight the findings associated with possible toxicity or increased toxicity risk. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=494426&lang=en > language: en > subject: Medication Administration > category: PPT ## Question The nurse reviews a follow-up note for a client taking digoxin. Which findings require immediate follow-up before the next dose? Highlight the findings associated with possible toxicity or increased toxicity risk. Nurses' Notes 0830: The home-care nurse completes a medication follow-up. The client states that digoxin is taken at the prescribed time each morning. The client denies missing or doubling a dose. At rest, the apical pulse is regular at 72/min. During breakfast, the client reports new nausea and yellow halos around the kitchen lights. The current weight is unchanged from last week's measurement. Today's laboratory report shows a potassium level of 4.2 mEq/L. At 0900, reassessment shows an apical pulse of 46/min with new dizziness on standing. A digoxin level was collected eight hours after yesterday's dose. The record confirms that the blood sample was timed eight hours after the dose. Last month's creatinine was 0.9 mg/dL. Today, creatinine is 1.8 mg/dL and potassium is 3.0 mEq/L. The medication list has not otherwise changed. The client reports that the daily weight remains within 0.5 kg of baseline. The nurse observes that the client uses a dated pill organizer for all scheduled doses. The next digoxin dose has not been taken. ## Explanation Follow up on nausea with yellow halos, an apical pulse of 46/min with dizziness, and worsening renal function with hypokalemia. Digoxin toxicity can involve gastrointestinal, visual, and cardiac findings and is more likely with renal or electrolyte problems. ## In-depth explanation Quick answer Hold and clarify the next dose because the client reports nausea with yellow halos, has an apical pulse of 46/min with new dizziness, and now has both worsening renal function and a potassium level of 3.0 mEq/L. Why this is correct Digoxin toxicity can produce gastrointestinal symptoms, visual changes, bradycardia, heart block, and other dysrhythmias. Impaired renal clearance and electrolyte abnormalities, including hypokalemia, increase susceptibility. The clinical pattern matters because toxicity may occur even when one isolated serum value is not clearly high.[2] Easy analogy or mental picture Think of digoxin as a narrow bridge: kidney clearance and potassium help keep the client centered. When clearance slows or potassium falls, symptoms can signal that the client is drifting toward the edge. The bridge picture does not replace pulse, rhythm, laboratory, and symptom assessment. Memory hook Gut, sight, rhythm, clearance: new trouble in these lanes means stop and check. NCLEX decision rule Before giving a medication with a narrow safety margin, connect new symptoms to the pulse, renal function, electrolytes, and interacting drugs. Hold and clarify when the combined pattern suggests toxicity rather than relying on one reassuring detail. Why the other choices are wrong Taking the medication consistently, a pulse of 72/min, stable weight, normal potassium, an appropriately timed level, stable kidney function, and use of a pill organizer do not independently show the same toxicity pattern in this record.References - [1]NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing - [2]DailyMed: Digoxin Tablet Prescribing InformationU.S. National Library of Medicine ## Related questions - [Before giving a scheduled dose of digoxin, the nurse obtains an apical pulse of 54/min in …](https://mymerci.kr/pages/nclex_q.php?qn_id=374883&lang=en) - [An older adult taking digoxin reports nausea, poor appetite, and yellow-green halos. 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