A nurse is preparing to administer ceftriaxone 1 g intermittent IV bolus to a client over 30 min. Available is ceftriaxone 1 g in 100 mL of dextrose 5% in water. The nurse should set the pump to deliver how many mL per hr? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

Miosis : Pinpoint pupils are a hallmark of opioid overdose due to stimulation of the parasympathetic nervous system. This finding helps distinguish opioid toxicity from other types of substance use, which often cause pupil dilation instead.

Respiratory depression : Opioids depress the medullary respiratory centers in the brainstem, leading to slowed breathing. A respiratory rate of 10/min is significantly reduced and signals impaired ventilation, making it a critical diagnostic clue.

Opioid overdose: The clinical signs—needle marks, sedation, pinpoint pupils, bradypnea, and a positive response to naloxone—all strongly point to an opioid overdose. A similar prior episode adds to the likelihood of chronic opioid misuse.

Alcohol intoxication: While alcohol can depress the central nervous system, it does not typically cause miosis or respond to naloxone. Also, the pattern of rapid reversal with naloxone suggests opioid involvement rather than alcohol alone.

Benzodiazepine overdose: Though it shares features like sedation and respiratory depression with opioid overdose, benzodiazepine toxicity does not cause miosis, and naloxone has limited or no effectiveness as a reversal agent.

Cocaine intoxication : Typically causes stimulant effects including mydriasis (dilated pupils), increased heart rate, hypertension, and agitation. These are not consistent with the symptoms in this case, which reflect CNS depression.

A. Refer the family to a chronic pain support group. While helpful, this is a later step in the care plan. The nurse must first assess the child's specific condition and patterns of pain.
B. Set up an appointment with the school nurse. This is a supportive measure but not the priority. The nurse must gather more information before involving school personnel.
C. Review the child's electronic pain diary. This is the first action because it allows the nurse to assess the frequency, triggers, severity, and duration of the migraines. Understanding the child's pain pattern is essential for effective treatment planning.
D. Request a change in medication from the provider. This may be necessary, but the nurse should first gather complete data on the child's symptoms and current response to treatment before suggesting changes to the medication regimen.