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.)

Answer: D. "I’ll take this medicine first thing in the morning."

A. "I should expect to feel better after 24 hours of starting this medication."
This statement indicates a misunderstanding of the medication's pharmacodynamics. Fluoxetine, a selective serotonin reuptake inhibitor (SSRI), generally requires a minimum of 4 to 6 weeks to exhibit therapeutic effects in treating depression. Clients may initially experience side effects, such as nausea or changes in sleep patterns, before noticing any improvement in mood. It's crucial to educate clients about this timeline to manage expectations and encourage adherence to the medication regimen.

B. "I should not take this medicine with grapefruit juice."
This statement is incorrect. While grapefruit juice can affect the metabolism of many medications due to its action on cytochrome P450 enzymes, fluoxetine is not significantly impacted by grapefruit juice. Therefore, clients can consume grapefruit juice without the risk of altering the effectiveness or safety of fluoxetine. Providing accurate dietary information is essential to ensure clients feel confident in their dietary choices while on medication.

C. "I’ll take this medicine with food."
While clients may take fluoxetine with food to help minimize potential gastrointestinal upset, it is not strictly necessary. The medication can be effective whether taken with or without food. This flexibility allows clients to choose the method that works best for their individual tolerance and lifestyle, which can improve adherence and comfort.

D. "I’ll take this medicine first thing in the morning."
This is the correct understanding. Taking fluoxetine in the morning is generally recommended because the medication can cause insomnia or increased alertness in some individuals, particularly when initiated. By taking it in the morning, clients can avoid potential sleep disturbances at night, which is important for maintaining a regular sleep-wake cycle and overall well-being. Additionally, consistent timing can help improve adherence to the treatment plan.

Answer: (B, C, D, E)

Rationale:

A) Damp dressing: A damp dressing around the IV site is typically indicative of a leaking IV or infiltration, where fluid escapes from the vein into the surrounding tissue. This finding is not directly related to phlebitis, which is inflammation of the vein.

B) Warmth at insertion site: Warmth at the insertion site is a common sign of phlebitis. The inflammation of the vein causes increased blood flow to the area, leading to localized warmth. This symptom is a key indicator that the IV site may be irritated or infected.

C) Streak formation: Streak formation, often seen as a red line running along the vein above the IV site, is a classic sign of phlebitis. It indicates inflammation and irritation spreading along the vein, which can occur due to the presence of the IV catheter.

D) Throbbing: Throbbing pain or discomfort at the IV site is another sign of phlebitis. The inflammation of the vein can cause pain that may be constant or increase with movement or palpation, indicating irritation or potential damage to the vessel.

E) Erythema: Erythema, or redness at the IV site, is a hallmark sign of phlebitis. The inflammation results in redness around the insertion area, which may spread along the vein, further indicating the presence of irritation or infection at the site.