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 is a cardiac glycoside with a narrow therapeutic range (0.5 to 2.0 ng/mL) and common signs of toxicity include anorexia (refusing food), nausea, vomiting, weakness, and vision changes. Checking vital signs, particularly the apical pulse for bradycardia (heart rate <60 beats per minute) or an irregular rhythm, is the nurse's priority action to assess for a potentially life-threatening cardiac manifestation of digoxin toxicity. Choice B rationale Requesting a dietitian consult addresses the symptom of refusing breakfast but is a non-urgent intervention. Before focusing on dietary intake, the nurse must first rule out a serious adverse drug effect like digoxin toxicity, which presents with gastrointestinal symptoms and weakness, requiring immediate clinical assessment and potential intervention. Choice C rationale Suggesting rest addresses the symptom of weakness but does not address the underlying potential cause, which could be digoxin toxicity or another acute medical issue. While rest may be helpful, the nurse's initial focus must be on objective assessment of the client's physiological status, which is best achieved through checking vital signs. Choice D rationale Requesting an antiemetic order addresses the symptom of nausea but treats only the symptom without investigating the cause. Masking the nausea could delay the detection of a serious underlying condition, such as digoxin toxicity, which requires prompt laboratory workup and potentially withholding the medication.