A nurse is caring for a client who has heart failure and has been taking digoxin 0.25 mg daily. The client refuses breakfast and reports nausea. Which of the following actions should the nurse take first?

Choice A rationale Resting before a meal is a common intervention for clients experiencing fatigue or dyspnea, which are typical symptoms of chronic heart failure. However, this action does not address the underlying cause of the current gastrointestinal symptoms. In a client taking digoxin, nausea and anorexia are classic early indicators of drug toxicity. Implementing rest without first assessing the client's physiological status ignores the potential for life-threatening cardiac arrhythmias associated with high serum digoxin levels. Choice B rationale Requesting an antiemetic is an appropriate intervention for symptomatic relief of nausea in many clinical scenarios. However, in the context of digoxin therapy, administering an antiemetic could dangerously mask a primary sign of digitalis toxicity. Digoxin has a narrow therapeutic index, typically 0.5 to 2 ng/mL. The nurse must prioritize determining if the nausea is a side effect of medication toxicity rather than simply treating the symptom, as toxicity requires immediate medical management and dose adjustment. Choice C rationale Assessing vital signs, specifically the apical pulse and blood pressure, is the priority action when digoxin toxicity is suspected. Digoxin works by inhibiting the sodium-potassium ATPase pump, which increases intracellular calcium and cardiac contractility. Toxicity can lead to profound bradycardia or other dysrhythmias. By checking vital signs first, the nurse obtains objective data regarding the client's current hemodynamic stability and cardiac rhythm, which is essential before notifying the provider or initiating further interventions. Choice D rationale A dietary consult may be beneficial for long-term management of heart failure to ensure the client follows a low-sodium, heart-healthy diet. However, it is not an appropriate initial response to acute nausea and refusal of food in a client on digitalis. The immediate nursing focus must be on safety and assessment of potential drug-related complications. Consulting a dietitian before excluding medication toxicity would delay necessary medical intervention for a potentially critical physiological imbalance.