The healthcare provider prescribes magnesium sulfate 300 mg/hour IV. The IV bag is contains magnesium sulfate 4 grams in dextrose 5% in water (DW) 500 mL. How many mL/hour should the nurse set the infusion pump? (Enter numerical value only. If rounding is required, round to the nearest tenth.)

A. Notify the healthcare provider of lethargy:
Cimetidine can cause side effects such as confusion and lethargy, especially in the elderly or those with renal impairment. Reporting these symptoms to the healthcare provider is important for proper management and potential adjustment of treatment.

B. Decrease cigarette use to a pack per day:
This statement indicates a misunderstanding of the impact of smoking on peptic ulcer disease. Smoking can exacerbate ulcer symptoms and interfere with healing. The nurse should instruct the client to ideally quit smoking altogether rather than just reducing the amount.

C. Monitor for any signs of sexual dysfunction:
Cimetidine can cause sexual dysfunction, including decreased libido and erectile dysfunction. The client should be aware of this potential side effect and report any such issues to their healthcare provider for further evaluation and management.

D. Take the medication an hour after antacids:
Cimetidine should not be taken simultaneously with antacids as this can interfere with its absorption. Taking cimetidine an hour after antacids is a correct approach to avoid interaction and ensure effective medication action.

A) Diarrhea: Diarrhea is a common side effect of many medications, including those used for nausea and vomiting. While it can be uncomfortable and may require management, it is generally less severe compared to neurological symptoms. Persistent diarrhea should be monitored and managed, but it does not typically indicate a serious underlying issue with metoclopramide.

B) Unusual irritability: Irritability can occur as a side effect of many medications and might be a sign of a mild central nervous system effect or a response to the stress of illness. While it is important to assess and address any changes in mood, unusual irritability is generally less urgent compared to neurological symptoms that could suggest more serious adverse effects.

C) Involuntary movements: Involuntary movements, such as tremors or muscle spasms, are significant concerns when a patient is on metoclopramide. These symptoms can indicate extrapyramidal side effects, which include tardive dyskinesia or other severe movement disorders. These conditions can be serious and potentially irreversible if not addressed promptly, making it crucial to report such symptoms immediately to the healthcare provider for further evaluation and intervention.

D) Nausea: Nausea is the primary symptom that metoclopramide is intended to treat, so its presence is expected and does not usually signal an adverse reaction to the medication. If nausea persists despite treatment, it might suggest the need for dose adjustment or an alternative treatment, but it is not an urgent adverse effect that requires immediate reporting compared to neurological symptoms.