A patient is in the emergency department with new-onset atrial fibrillation. Which order for digoxin would most likely have the fastest therapeutic effect?

Correct Answer: D

Rationale: When a patient requires immediate treatment for atrial fibrillation with digoxin, the fastest way to achieve a therapeutic effect is through intravenous administration. Option D, Digoxin 1 mg IV push now; then 0.25 mg IV daily, is the most appropriate order in this scenario. Intravenous administration allows for rapid absorption and onset of action, making it the preferred route for urgent situations like atrial fibrillation. By giving an initial loading dose intravenously, followed by a lower maintenance dose IV daily or orally, the patient can quickly achieve therapeutic digoxin levels to help stabilize the heart rhythm. Option D provides the most rapid and effective way to manage new-onset atrial fibrillation with digoxin.

Correct Answer: C

Rationale: When administering Penicillin, one of the adverse effects to watch out for as a sign of an acute allergic reaction is the development of a skin rash or hives. This reaction may indicate an allergic response to the medication. It is important for the nurse to monitor the patient closely for any signs of an allergic reaction, including skin changes, and to act promptly if such symptoms arise. An acute allergic reaction can progress to a severe life-threatening condition known as anaphylaxis, so prompt recognition and intervention are critical in such cases.

Correct Answer: A

Rationale: Spironolactone is a potassium-sparing diuretic, which means it inhibits sodium reabsorption in the kidneys, while saving potassium and hydrogen ions. It accomplishes this by acting as an aldosterone antagonist, blocking the action of aldosterone. Aldosterone is a hormone that normally promotes sodium reabsorption in the kidneys and leads to potassium and hydrogen ion excretion. By inhibiting aldosterone, spironolactone promotes sodium excretion while conserving potassium and hydrogen ions.

Correct Answer: A

Rationale: Myelosuppression, a common side effect of chemotherapy, leads to a decrease in white blood cells, red blood cells, and platelets. A drop in white blood cells, particularly neutrophils, increases the risk of infection. Monitoring for a change in temperature is critical because fever is often the first sign of infection in neutropenic patients. Early detection allows for prompt intervention, such as administering antibiotics, to prevent life-threatening complications. While gastrointestinal function, cardiac compromise, and changes in taste are important to assess, they are not as immediately life-threatening as an undetected infection in a myelosuppressed patient.

Correct Answer: B

Rationale: Topical corticosteroids can exacerbate viral infections, such as herpes simplex, by suppressing the immune response. They are contraindicated in the presence of viral infections to prevent worsening of the condition. Bacterial, parasitic, and spirochete infections are not absolute contraindications, although caution is advised.