A nurse starts an infusion of 1500 mL of normal saline (NS) for a client at 8:45 am at a flow rate of 2 mL/min. The tubing drop factor is 10 drops/mL.
Calculate the volume of fluid that will be left at 10:00 am.

This instruction should be given to the patient for the effective management of asthma because the patient is taking an overdose of ipratropium, which may cause serious side effects such as dry mouth, blurred vision, urinary retention, or increased heart rate. The recommended dosage of ipratropium for adults with acute asthma is 0.5 mg (500 mcg) every 20 minutes for three doses, followed by 0.5 mg every two to four hours as needed³. The patient's prescribed dose is 5 mg/kg, which means 300 mg/day for a 60 kg patient. This is 10 times the maximum daily dose of 2 mg (2000 mcg) for ipratropium⁴. Therefore, the patient should halve the dose of medication to 150 mg/day, which is still higher than the usual dosage, but within the range that can be given under medical supervision.

The other options are not appropriate instructions because:

a) Continuing the same dose of medication may worsen the patient's condition and increase the risk of adverse reactions.

b) Changing to alternative medication may not be necessary or effective, as ipratropium is a commonly used bronchodilator for asthma that works by relaxing the airway muscles and improving airflow⁵. The patient may benefit from adjusting the dose or adding other medications, such as corticosteroids or beta-agonists, depending on the severity and frequency of symptoms.

c) Doubling the dose of medication may be dangerous and potentially fatal, as it may cause severe anticholinergic effects, such as dry mouth, blurred vision, urinary retention, increased heart rate, confusion, or coma.

To find the rate in mL/hr, you need to calculate the following:

- The concentration of nitroglycerin in the IV solution in mcg/mL
- The infusion rate in mL/hr using the formula: Infusion rate (mL/h) = (Dose (mcg/min) x 60 min/h) / Concentration (mcg/mL)

First, convert the concentration of nitroglycerin from mg to mcg by multiplying by 1000:

125 mg x 1000 = 125,000 mcg

Then, divide the amount of nitroglycerin by the volume of the IV solution to get the concentration in mcg/mL:

125,000 mcg / 500 mL = 250 mcg/mL

Next, plug in the values into the formula for infusion rate:

Infusion rate (mL/h) = (42 mcg/min x 60 min/h) / 250 mcg/mL

Simplify and solve for the infusion rate:

Infusion rate (mL/h) = 10.08 mL/h

Therefore, the nurse should program the IV pump to deliver **10.1 mL/h** to infuse nitroglycerin at 42 mcg/minute.