A healthcare provider orders nitroprusside (100 mg/1 mL) 3 mcg/kg/minute for a patient weighing 154 lb. What rate (mL/hr) should the nurse program into the IV pump?

This instruction should be given to the patient for the effective management of asthma because the patient is taking an overdose of ipratropium, which may cause serious side effects such as dry mouth, blurred vision, urinary retention, or increased heart rate. The recommended dosage of ipratropium for adults with acute asthma is 0.5 mg (500 mcg) every 20 minutes for three doses, followed by 0.5 mg every two to four hours as needed³. The patient's prescribed dose is 5 mg/kg, which means 300 mg/day for a 60 kg patient. This is 10 times the maximum daily dose of 2 mg (2000 mcg) for ipratropium⁴. Therefore, the patient should halve the dose of medication to 150 mg/day, which is still higher than the usual dosage, but within the range that can be given under medical supervision.

The other options are not appropriate instructions because:

a) Continuing the same dose of medication may worsen the patient's condition and increase the risk of adverse reactions.

b) Changing to alternative medication may not be necessary or effective, as ipratropium is a commonly used bronchodilator for asthma that works by relaxing the airway muscles and improving airflow⁵. The patient may benefit from adjusting the dose or adding other medications, such as corticosteroids or beta-agonists, depending on the severity and frequency of symptoms.

c) Doubling the dose of medication may be dangerous and potentially fatal, as it may cause severe anticholinergic effects, such as dry mouth, blurred vision, urinary retention, increased heart rate, confusion, or coma.

To find the milliliters per minute, you need to calculate the following:

- The volume of Lopressor in milliliters
- The infusion rate in milliliters per minute using the formula: Infusion rate (mL/min) = Total volume (mL) / Time (min)

First, divide the dose of Lopressor by the concentration to get the volume in milliliters:

5 mg / 1 mg/mL = 5 mL

Next, use the formula for infusion rate to find how many milliliters per minute the IV pump should deliver:

Infusion rate (mL/min) = Total volume (mL) / Time (min)

Since the total volume is 5 mL and the time is 60 seconds or 1 minute, plug in these values into the formula:

Infusion rate (mL/min) = 5 mL / 1 min

Simplify and solve for the infusion rate:

Infusion rate (mL/min) = 5 mL/min

Therefore, the nurse should administer **5 mL/min** to infuse Lopressor 5 mg over 60 seconds.