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. Tachycardia: Tachycardia is common in diabetic ketoacidosis (DKA) due to dehydration, electrolyte imbalances, and compensatory mechanisms for hypotension. The heart rate increases to maintain adequate perfusion in response to fluid loss and acidosis.

B. HCO3 in expected range: In DKA, bicarbonate (HCO3) levels are decreased due to metabolic acidosis. The body uses bicarbonate to buffer excess ketone acids, so HCO3 is typically below the normal range, not within expected limits.

C. Increased PaCO2: In DKA, PaCO2 is usually decreased due to Kussmaul respirations (deep, rapid breathing) as the body attempts to compensate for metabolic acidosis by blowing off CO2. Elevated PaCO2 would indicate hypoventilation, which is not characteristic of DKA.

D. Hyperreflexia: DKA does not typically cause hyperreflexia. Neurological changes, if present, are more likely to involve lethargy, confusion, or coma due to severe acidosis, dehydration, and electrolyte imbalances, rather than exaggerated reflexes.

Rationale:

A. Calcium: While calcium is important for many bodily functions, it is not a primary indicator for monitoring hepatic encephalopathy. Calcium imbalances do not directly correlate with the severity or management of this condition.

B. Potassium: Potassium levels are important for overall electrolyte balance, but they are not specific to hepatic encephalopathy. Monitoring potassium is part of routine care but does not indicate the progression or severity of encephalopathy.

C. Ammonia: Elevated ammonia levels are a key contributor to hepatic encephalopathy. The liver normally converts ammonia to urea, and when liver function is impaired, ammonia accumulates, affecting neurological function. Monitoring ammonia helps assess severity and guide treatment interventions.

D. Glucose: While glucose monitoring is important in general care, it is not specific to hepatic encephalopathy. Hyper- or hypoglycemia may occur with liver disease but does not directly reflect the presence or progression of encephalopathy.