A nurse is preparing to administer 0.9% sodium chloride 1,000 mL. IV to infuse over 8 hr. The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero)

A. “I should practice pursed-lip breathing exercises.": This technique involves inhaling through the nose and exhaling slowly through pursed lips (as if whistling). This creates back-pressure in the airways, which keeps the bronchioles open longer during exhalation. This helps the client remove trapped carbon dioxide (CO2), reduces shortness of breath, and promotes relaxation.

B. "I will consume low-protein, low-calorie foods": Clients with COPD require adequate protein and calories to maintain muscle mass and energy for breathing. Restricting protein and calories could worsen muscle wasting and fatigue.

C. “I should do aerobic exercises once per day": While regular physical activity is beneficial, exercise should be paced and tailored to the client’s tolerance. Overexertion can exacerbate dyspnea and fatigue in COPD clients.

D. "I will increase my fluid intake to 1,700 milliliters per day.": While hydration is important to thin secretions, 1,700 mL is on the lower end of standard daily requirements for an adult. Clients with COPD are encouraged to drink 2 to 3 liters (2,000 to 3,000 mL) of fluid per day (unless contraindicated by heart failure) to help liquefy thick mucus, making it easier to cough up.

Rationale for correct choices:

• Yellowing of the eyes: Yellowing of the sclera indicates jaundice, which can occur with hepatotoxicity caused by isoniazid, rifampin, or pyrazinamide. These medications are metabolized by the liver and can cause liver inflammation or failure. Early recognition of jaundice is critical to prevent progression to severe hepatic injury.

• Blurred vision: Ethambutol is associated with optic neuritis, which can present as blurred vision or changes in visual acuity. This adverse effect can be irreversible if not identified early. Regular visual assessment is essential during therapy. Any report of visual changes requires immediate provider notification.

• Abdominal pain: Abdominal pain may indicate liver irritation or hepatitis related to antitubercular medications. Isoniazid, rifampin, and pyrazinamide commonly cause hepatotoxic effects. Abdominal discomfort, especially in the right upper quadrant, can signal worsening liver function. Prompt assessment helps prevent serious complications.

• Increased bruising: Increased bruising can indicate impaired liver synthesis of clotting factors due to hepatotoxicity. Rifampin and isoniazid may contribute to coagulation abnormalities. This finding suggests compromised hepatic function and increased bleeding risk.

• Increased bleeding tendency: A tendency to bleed reflects potential liver dysfunction affecting clotting factor production. Antitubercular therapy–related hepatotoxicity can lead to coagulopathy. This is a serious adverse reaction requiring immediate evaluation. Early detection reduces the risk of hemorrhage.

• Darkening of the urine: Dark urine can be a sign of elevated bilirubin levels from liver injury. Rifampin may also discolor urine, but when combined with other hepatic symptoms, it raises concern for hepatotoxicity. Monitoring urine color helps differentiate benign effects from serious complications. This finding warrants further liver assessment.

Rationale for incorrect choices:

• Dry eyes: Dry eyes are not associated with serious adverse reactions to tuberculosis medications. This finding does not indicate optic nerve involvement or liver toxicity. It is related to environmental or minor irritative causes.

• Weight gain: Weight gain is not a known adverse effect of first-line tuberculosis medications. In fact, weight loss is more common due to infection and medication side effects. This finding does not indicate toxicity.

• Insomnia: Although sleep disturbances may occur with illness or stress, insomnia is not a serious adverse reaction related to the prescribed medications. It does not signal organ toxicity. Other findings are more clinically significant.

• Urinary frequency: Urinary frequency is not associated with antitubercular medication toxicity. Genitourinary adverse effects typically involve urine discoloration rather than changes in frequency. This finding does not suggest a serious reaction.