A nurse is preparing to administer ciprofloxacin 400 mg by intermittent IV infusion to a client over 60 min. Available is ciprofloxacin 400 mg in dextrose 5% in water (DSW) 200 mL. The nurse should set the 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

• Inspect the child's oropharynx: Vomiting bright red emesis after tonsillectomy indicates possible postoperative hemorrhage. Immediate inspection of the oropharynx allows the nurse to assess the source, amount, and severity of bleeding. Prompt identification of bleeding is critical to prevent hypovolemic shock and guide urgent interventions.

• Obtaining a set of vital signs: Vital signs provide objective data about the child’s hemodynamic status. Tachycardia, hypotension, or altered respiratory rate may indicate significant blood loss. Monitoring blood pressure, heart rate, and oxygen saturation helps determine the urgency of treatment and guides fluid resuscitation or other emergency measures.

Rationale for incorrect choices

• Place the child in a supine position: Placing the child supine could worsen bleeding or increase the risk of aspiration if emesis occurs. Standard care is to maintain the child upright or sitting forward to allow drainage and minimize airway compromise. Supine positioning is not appropriate immediately after post-tonsillectomy bleeding.

• Offer the child a red popsicle: Red-colored foods or drinks can mask the presence of ongoing bleeding, delaying recognition of hemorrhage. It is unsafe to offer red popsicles until bleeding is ruled out and the child is stable. Non-red liquids or clear fluids are safer during assessment.

• Encouraging the child to cough and deep breathe: While coughing and deep breathing are important for postoperative respiratory care, they are contraindicated if active bleeding is suspected. Coughing could dislodge clots and exacerbate hemorrhage. Airway safety and hemodynamic assessment take priority.

• Requesting a prescription for codeine: Administering codeine for pain is inappropriate in the presence of suspected bleeding because opioids can mask symptoms and depress respirations. Pain management should be secondary to stabilization and assessment of hemorrhage risk.

Rationale:

A. Lack of empathy: This is characteristic of narcissistic personality disorder rather than obsessive-compulsive personality disorder (OCPD). Clients with OCPD may appear rigid and controlling but do not typically demonstrate a profound lack of empathy.

B. Fear of abandonment: This is a hallmark feature of borderline personality disorder, not OCPD. Clients with OCPD usually struggle with control, orderliness, and perfectionism rather than intense fears of being abandoned.

C. Distrust of others: Distrust is more indicative of paranoid personality disorder. While OCPD clients may be critical or controlling, pervasive suspicion and mistrust are not primary features.

D. Focus on perfectionism: A hallmark manifestation of OCPD is a preoccupation with order, rules, and perfectionism. Clients may become inflexible, excessively devoted to work, and unable to delegate tasks due to their high standards, making this the expected finding.