A nurse is caring for a client who has congestive heart failure and is taking digoxin daily. The client refused breakfast and is complaining of nausea and weakness. Which of the following actions should the nurse take first?

Choice A rationale Digoxin has a narrow therapeutic index, typically 0.5 to 2.0 ng/mL. Nausea and weakness are classic early signs of digoxin toxicity. Checking vital signs, particularly the apical pulse, is the priority nursing action to assess for bradycardia or dysrhythmias caused by toxic levels. Assessing the physiological status of the client provides immediate data to determine the severity of the situation before proceeding with further interventions or contacting the provider for laboratory testing. Choice B rationale Requesting an antiemetic addresses the symptom of nausea but fails to investigate the underlying cause, which is likely digoxin toxicity. Masking the nausea with medication could delay the diagnosis of a potentially life-threatening cardiac complication. In the context of heart failure and digoxin use, any new onset of gastrointestinal distress must be treated as a sign of toxicity until proven otherwise. Assessment of the client's current clinical stability must always precede symptomatic treatment. Choice C rationale A dietitian consult is an inappropriate and delayed response to an acute clinical change. While nutritional support is important for chronic congestive heart failure management, the immediate complaints of nausea and weakness suggest a drug-related complication rather than a primary dietary issue. Focusing on nutrition at this moment ignores the urgent safety risk posed by digoxin. The nurse must prioritize assessment of the client's cardiac and neurological status over long-term dietary planning. Choice D rationale Suggesting rest before eating is a passive intervention that ignores the diagnostic significance of the client's symptoms. Nausea in a client taking digoxin is a red flag that requires active clinical evaluation. Waiting for the client to rest does not provide the nurse with necessary data regarding heart rate or rhythm stability. The priority is to identify signs of toxicity early to prevent cardiac arrest or severe conduction blocks associated with high digoxin levels.