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)

Rationale for correct choices:

• Suicide: The client verbalizes hopelessness, worthlessness, and passive death wishes, stating “I wish I weren’t here.” There is a prior history of threatening to kill self and recent significant psychosocial stressors, including loss of a relationship and employment. Placement on one‑to‑one observation indicates concern for imminent self-harm risk.

• Suicidal ideation: The client expresses passive thoughts of not wanting to exist and significant emotional distress. Statements reflecting hopelessness and desire to escape life stressors are key indicators of suicidal ideation. These findings directly support an increased risk for suicide in the context of the patient’s depression.

Rationale for incorrect choices:

• Self mutilation: There is no evidence of deliberate self-injury behaviors such as cutting or burning. The client’s statements reflect thoughts about death rather than non-suicidal self-injury used to cope with emotional distress.

• Substance abuse: No information indicates current or past misuse of alcohol or drugs. The client’s symptoms are centered on mood disturbance, loss, and hopelessness rather than substance-seeking behavior or intoxication.

• Acute stress disorder: Acute stress disorder occurs shortly after a traumatic event and includes dissociation, intrusion symptoms, and hyperarousal. The client’s presentation reflects depressive symptoms and suicidal thoughts rather than trauma-related responses.

• Borderline personality disorder: There is no documented pattern of unstable relationships, impulsivity, identity disturbance, or chronic emotional dysregulation. The current symptoms are better explained by depression with suicidal ideation rather than a personality disorder.

• Ethambutol: Ethambutol is part of the standard initial four-drug regimen for active TB. It helps prevent the development of drug resistance while susceptibility results are pending and is routinely anticipated in treatment plans.

• Isoniazid: Isoniazid is a first-line antitubercular medication used to inhibit mycolic acid synthesis in the bacterial cell wall. It is a core component of therapy for active TB and is expected unless contraindicated by liver toxicity.

• Airborne precautions: TB is transmitted via airborne droplet nuclei, requiring airborne isolation to prevent spread. Negative-pressure rooms and appropriate respiratory protection are standard and anticipated nursing interventions.

• Rifampin: Rifampin is another first-line medication that works by inhibiting bacterial RNA synthesis. It is essential for effective TB treatment and is routinely included in combination therapy.

• Pyrazinamide: Pyrazinamide enhances the sterilizing effect of TB treatment during the intensive phase. It is anticipated in early treatment to shorten therapy duration and improve outcomes.

• Monthly TB skin test for 1 year: Once active TB is confirmed, skin testing is no longer useful for monitoring treatment response. The TB skin test detects exposure, not disease activity or resolution, making it inappropriate in this context.

• Contact precautions: TB does not spread through direct contact or contaminated surfaces. Airborne precautions are required instead, so contact precautions alone are insufficient and not indicated for TB management.