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:

A. Confusion: Confusion is an early neurological manifestation of hypoglycemia caused by insufficient glucose supply to the brain. Clients may also experience irritability, shakiness, or difficulty concentrating, which are key indicators to assess for after insulin administration.

B. Acetone breath: Acetone or fruity breath odor is associated with diabetic ketoacidosis (DKA), a hyperglycemic emergency, not hypoglycemia. This occurs due to ketone buildup when insulin is deficient, which is opposite of low blood glucose.

C. Polydipsia: Excessive thirst is a symptom of hyperglycemia, not hypoglycemia. It occurs when elevated glucose levels cause osmotic diuresis, leading to dehydration and thirst, and is not expected shortly after insulin lispro administration.

D. Hot, dry skin: Hot, dry skin is typically associated with hyperglycemia or fever. In hypoglycemia, the client often exhibits cool, clammy skin due to sympathetic nervous system activation and sweating, making this finding inconsistent with low blood glucose.

Rationale:

A. Encourage the client to elevate their legs while in bed: Elevating the affected leg helps reduce venous pressure, decreasing edema and discomfort associated with DVT. Elevation also promotes venous return, which can limit further clot propagation. This intervention provides symptom relief without increasing the risk of embolization.

B. Place an immobilizer on the affected leg: Immobilizers restrict movement and are used for musculoskeletal injuries, not for DVT management. Immobilization can worsen venous stasis by reducing circulation in the lower extremity. Instead, clients with DVT benefit from gentle mobility once anticoagulation is initiated, unless contraindicated, to prevent worsening clot burden.

C. Implement bleeding precautions: The client has diagnostic confirmation of DVT and will require anticoagulation, which increases bleeding risk. Bleeding precautions help prevent complications such as hematuria, bruising, or gastrointestinal bleeding. Monitoring for signs of bleeding and avoiding trauma are essential once therapy begins.

D. Apply intermittent pneumatic compression devices to the unaffected leg: IPC devices should not be applied to the affected limb due to the risk of dislodging the thrombus. However, using them on the unaffected leg promotes venous return and helps prevent additional clot formation.

E. Instruct the client to expect dark stools: Dark stools can indicate gastrointestinal bleeding, which is not an expected effect of DVT treatment. While anticoagulants can increase bleeding risk, the nurse should teach the client to report black or tarry stools immediately.