A nurse is preparing to administer total parental nutrition (TPN) 1800 mL to infuse over 24 hr. 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.)

A. "I'll be glad when I can stop taking this medicine.": This statement indicates a misunderstanding about phenytoin therapy. Phenytoin is typically a long-term medication used to prevent seizures, and it is not typically discontinued unless under the guidance of a healthcare provider. The nurse should clarify that stopping the medication abruptly can lead to rebound seizures and should emphasize the importance of continuing the medication as prescribed.

B. "I have made an appointment to see my dentist next week.": This statement indicates appropriate understanding, as regular dental check-ups are important for individuals taking phenytoin due to the medication's potential side effect of gingival hyperplasia.

C. "I know that I cannot switch brands of this medication.": This statement demonstrates understanding, as different brands of phenytoin can have variations in bioavailability, which can affect seizure control. It is important for clients to remain consistent with the same brand or formulation unless directed otherwise by their healthcare provider.

D. "I will notify my doctor before taking any other medications.": This statement indicates understanding of the potential for drug interactions with phenytoin, as it is a hepatic enzyme inducer and can affect the metabolism of other medications. Clients should always consult their healthcare provider before taking any new medications or supplements to ensure compatibility with phenytoin therapy.

Lithium is a mood stabilizer commonly prescribed for bipolar disorder, but it has a narrow therapeutic index, meaning the difference between a therapeutic dose and a toxic dose is small. Therefore, it's crucial for the client to recognize the signs of lithium toxicity. Here's the rationale for each option:

A. "Vomiting is an indication of toxicity.": This statement is correct. Vomiting is one of the early signs of lithium toxicity and should be reported to the healthcare provider immediately.

B. "I will report any loss of appetite.": While loss of appetite can be a symptom of lithium toxicity, it is not one of the most common or specific signs. Other symptoms, such as vomiting, diarrhea, tremors, and confusion, are more indicative of lithium toxicity.

C. "I will call my provider if I experience any headaches.": Headaches are not typically associated with lithium toxicity. Symptoms such as severe diarrhea, tremors, confusion, and decreased coordination are more indicative of lithium toxicity.

D. "Increased flatulence is an indication of toxicity.": Increased flatulence is not a typical manifestation of lithium toxicity. Symptoms such as gastrointestinal upset, tremors, confusion, and changes in coordination are more common signs of toxicity.