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.)

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.

A. Clamping the catheter: Clamping the catheter may interrupt the flow of fluids or medications, which could worsen the client's condition. This action is not appropriate as the first intervention.

B. Initiate oxygen therapy: Acute shortness of breath is a critical symptom that requires immediate intervention to ensure adequate oxygenation. Initiating oxygen therapy is the priority action to improve the client's oxygenation status while further assessment and interventions are conducted.

C. Auscultate breath sounds: Assessing breath sounds is an essential component of the assessment for a client experiencing shortness of breath. However, in this scenario, the priority is to ensure the client's oxygenation needs are met by initiating oxygen therapy first.

D. Position the client in left lateral Trendelenburg: Positioning the client in left lateral Trendelenburg may help optimize oxygenation by improving blood flow and ventilation-perfusion matching. However, this action is not the priority compared to initiating oxygen therapy, which directly addresses the client's respiratory distress.