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

• The statement "Why don't you just leave me? I am of no use" reflects hopelessness, a high‑risk indicator for self‑harm in older adults. Expressions of worthlessness or being a burden require immediate follow‑up because they signal severe depression or suicidal ideation. The priority is ensuring safety and initiating urgent mental health evaluation.

• The report of cognitive decline accompanied by worsening memory, disordered thought process, and impaired self‑care indicates a significant functional deterioration. These symptoms can reflect rapidly progressing depression, delirium, or early dementia. Any acute decline in cognition or functional ability in an older adult warrants prompt assessment to identify reversible causes.

• Loss of appetite with an 8‑lb weight loss in one month suggests clinically significant unintentional weight loss. Combined with decreased interest in eating, this is a red flag for major depressive disorder, frailty progression, or underlying illness. Sudden nutritional decline increases morbidity risk and requires timely intervention.

• Poor eye contact, monotone speech, and flat facial expression are key affective indicators of depression. These signs, when combined with statements of worthlessness, suggest severe depressive symptoms that require urgent assessment and intervention to prevent further decline.

Rationale for incorrect choices

• Sleeping 7 hours per night with 1–2 awakenings to urinate can be normal for older adults. This finding does not indicate acute risk and is not a priority compared with weight loss, cognitive decline, or suicidal statements. It can be evaluated during routine assessment rather than requiring urgent follow‑up.

• Heart rate 68/min is within normal limits for an older adult and does not signal instability or deterioration. It does not require immediate intervention and can be monitored routinely while priority concerns related to mood, cognition, and safety are addressed.

Rationale:

A. Monitor the height and tone of the client's fundus: Assessing uterine fundus is essential postpartum, especially with signs of infection and moderate lochia. Monitoring for firmness, height, and consistency helps identify uterine atony or worsening infection, guiding timely interventions to prevent hemorrhage or complications.

B. Inform the client she will need to formula feed her newborn until she has received antibiotics for 24 hr: Most antibiotics prescribed for postpartum infections, such as clindamycin, are considered compatible with breastfeeding. Advising formula feeding unnecessarily could disrupt breastfeeding without clinical justification.

C. Initiate contact precautions: Postpartum infections like endometritis or mastitis are generally not spread via contact in a hospital setting. Standard precautions, including hand hygiene, are sufficient unless a specific transmissible pathogen is identified.

D. Instruct the client to wash her hands before and after changing her perineal pad: Hand hygiene prevents the spread of infection and reduces the risk of secondary infections. Teaching proper handwashing is an essential standard precaution for clients with postpartum infections.

E. Obtain a culture specimen of the lochia from the client's perineal pad using a sterile swab: Routine cultures of lochia are not indicated unless there is suspicion of an unusual pathogen or worsening infection. Assessment and empiric antibiotics are standard for postpartum endometritis based on clinical findings.

F. Encourage the client to maintain a semi-Fowler's position to enhance uterine drainage: Semi-Fowler’s positioning promotes uterine drainage, reduces stasis of lochia, and supports comfort. This position aids in preventing complications such as uterine infection or retention of lochia.

G. Request a prescription for terbutaline from the provider: Terbutaline is a tocolytic used to suppress preterm labor. It is not indicated for postpartum infection, uterine atony, or lochia management and is not appropriate in this scenario.