A nurse is preparing to administer lidocaine via continuous IV infusion at 4 mg/min. Available is lidocaine 2 g dextrose 5% in water 500 mL. The nurse should set the IV 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.)

Choice A Reason:
Absence of deep-tendon reflexes is correct. The absence or decrease in deep-tendon reflexes can be a sign of magnesium toxicity. Magnesium sulfate, when given in excessive amounts or in the case of accumulation due to impaired renal function, can lead to muscle weakness, hyporeflexia, and in severe cases, loss of deep-tendon reflexes. Discontinuation of magnesium sulfate and administration of calcium gluconate is warranted in severe cases of magnesium toxicity to counteract its effects.
Choice B Reason:
Report of chills is incorrect. Chills are non-specific symptoms and are not typically associated specifically with magnesium toxicity. They are less indicative of a need for calcium gluconate administration in the context of magnesium sulfate infusion.
Choice C Reason:
Decreased level of consciousness is correct. Severe magnesium toxicity can affect the central nervous system, leading to symptoms like confusion, drowsiness, and eventually decreased level of consciousness. In these cases, discontinuation of magnesium sulfate and administration of calcium gluconate is crucial to counteract the effects of excessive magnesium.
Choice D Reason:
Systolic blood pressure of 130 mm Hg is incorrect. A systolic blood pressure of 130 mm Hg, by itself, is not an indicator of magnesium toxicity that necessitates the administration of calcium gluconate. Blood pressure within this range is not typically a cause for concern related to magnesium sulfate administration.
Choice EReason:
Urine output of 80 mL in 4 hours is incorrect. While decreased urine output might indicate potential renal issues or compromised kidney function, it's not a specific indication for the administration of calcium gluconate in the context of magnesium sulfate infusion. It can signal the need for further assessment but is not a direct sign of magnesium toxicity requiring calcium gluconate administration.

Choice A Reason:
Weight loss is incorrect. While weight loss can be a side effect of citalopram, it's not typically considered a severe or urgent adverse effect that requires immediate reporting to the provider. It's more often observed in some individuals as a common side effect of this medication.
Choice B Reason:
Confusion can indicate a severe or uncommon adverse reaction to citalopram, especially in the context of treating major depression. It could potentially signify a serious condition that requires immediate attention. Reporting confusion promptly allows the healthcare provider to assess the situation and make appropriate adjustments to the medication regimen or provide additional interventions if necessary.
Choice C Reason:
Insomnia is incorrect. Insomnia is another potential side effect of citalopram. While it can affect the individual's quality of life, it's not typically an adverse effect that would be considered an urgent concern requiring immediate reporting to the provider.
Choice D Reason:
Bruxism is incorrect. Bruxism, or teeth grinding, is a less common side effect of citalopram. While it can cause discomfort or dental issues, it's not typically considered a priority adverse effect that necessitates immediate reporting to the provider compared to confusion, which might indicate a more serious or severe reaction.