# A 70-year-old client on long-term digoxin therapy reports new yellow-green halos around lights, anorexia, and unusual fatigue over the past two days. Which intervention should the nurse take FIRST?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=374884&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A 70-year-old client on long-term digoxin therapy reports new yellow-green halos around lights, anorexia, and unusual fatigue over the past two days. Which intervention should the nurse take FIRST?

## Option

1. Encourage the client to eat more bananas to balance electrolytes before the next dose
2. Document the findings and reschedule for the next routine clinic visit
3. Administer the next scheduled dose and reassess after four hours
4. Hold the dose, notify the provider, and obtain a serum digoxin level and basic metabolic panel **✔ Correct answer**

**Correct answer: 4**

## Explanation

Why option 4 is correct
The client is reporting classic HALOS toxicity: yellow-green visual halos (Ocular), anorexia (Anorexia), and fatigue (Lethargy). Digoxin has a narrow therapeutic index, so any concerning symptom requires holding the dose, immediate provider notification, and a serum digoxin level plus a basic metabolic panel (potassium, magnesium, creatinine).

Why the other options are wrong
Option 3 administers an additional dose to a possibly already-toxic client, worsening the toxicity. Option 1 ("eat more bananas") is a piecemeal home remedy that does not address possible serum levels and delays diagnosis. Option 2 documents but defers — toxicity is time-sensitive and can deteriorate to life-threatening arrhythmia.

## In-depth explanation

HALOS recognition
Headache, Anorexia, Lethargy, Ocular changes (yellow-green halos, blurred or hazy vision, photophobia), GI Symptoms (nausea, vomiting, abdominal pain, diarrhea). Vision-related complaints are particularly characteristic.

Why level + electrolytes matter together
Hypokalemia (K 10 ng/mL, life-threatening arrhythmia, hyperkalemia >5 in acute overdose).

## Clinical scenario

Clinical scenario
The client is at the cardiology outpatient clinic for a routine follow-up appointment. The presenting complaint of "the lights have weird halos around them" was volunteered to the medical assistant during intake.

## Key concepts

- **HALOS toxicity acronym** — Headache, Anorexia, Lethargy, Ocular changes (yellow-green halos, blurred vision), GI Symptoms (nausea, vomiting, diarrhea). Vision changes are highly specific to digoxin toxicity.
- **Why hold + level + BMP** — Hold the dose, draw a serum digoxin level (therapeutic 0.5-2 ng/mL), and a basic metabolic panel for K, Mg, and creatinine. Hypokalemia or renal impairment may explain toxicity at therapeutic levels.
- **Digoxin immune Fab (Digibind) indications** — Severe toxicity: serum level >10 ng/mL in chronic toxicity, life-threatening arrhythmia (Vfib, sustained Vtach, complete heart block, severe bradycardia unresponsive to atropine), hyperkalemia >5 in acute overdose, ingestion >10 mg adult or >4 mg pediatric.

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