The nurse receives a prescription for ciprofloxacin 400 mg intravenously (IV) every 12 hours to be infused over an hour. The IV bag contains ciprofloxacin 400 mg in dextrose 5% in water (D5W) 200 mL. The nurse should program the infusion pump to deliver how many mL/hr? (Enter numerical value only.)

Choice A reason: Determining when the last dose was administered is important to ensure safe and effective pain management, but it is not the first action that the nurse should implement. The nurse should first assess the client's pain level and intensity before deciding on the appropriate dose and frequency of pain medication.

Choice B reason: Encouraging the client to use diversional thoughts to manage pain is a non-pharmacological intervention that can help reduce pain perception and anxiety, but it is not sufficient to address severe or acute pain. The nurse should first assess the client's pain level and intensity before suggesting any complementary or alternative therapies.

Choice C reason: Asking the client to rate the current level of pain using a pain scale is the first action that the nurse should implement, as it can help quantify and communicate the client's pain experience and guide the nurse's decision on pain medication. The nurse should use a valid and reliable pain scale that is appropriate for the client's age, cognitive ability, and language preference.

Choice D reason: Reviewing the history for a past use of recreational drugs is relevant to assess the client's risk of addiction or tolerance to pain medication, but it is not the first action that the nurse should implement. The nurse should first assess the client's pain level and intensity before considering any factors that may influence pain management.

Choice B reason: Ciprofloxacin is a fluoroquinolone antibiotic that can treat anthrax, a serious bacterial infection that can affect the skin, lungs, or digestive system. Ciprofloxacin can cause tendonitis or tendon rupture, especially in older adults or those who take corticosteroids. Tendonitis is the inflammation of a tendon, which is a tissue that connects muscle to bone. Tendon rupture is the tearing or breaking of a tendon. These conditions can cause severe pain, swelling, bruising, or difficulty moving the affected area. Therefore, the nurse should instruct the client to report any tendon pain or swelling to the healthcare provider immediately and stop taking ciprofloxacin until further evaluation.

Choice C reason: Increasing fluid intake while taking the medication is an instruction that should be included in the teaching plan, because ciprofloxacin can cause crystalluria, or the formation of crystals in the urine. Crystalluria can lead to kidney stones, kidney damage, or urinary tract obstruction. Therefore, the nurse should advise the client to drink at least 2 liters of water per day while taking ciprofloxacin to prevent crystalluria and maintain kidney function.

Choice E reason: Limiting exposure to sunlight and avoiding tanning beds is an instruction that should be included in the teaching plan, because ciprofloxacin can cause photosensitivity, or increased sensitivity to sunlight or artificial ultraviolet light. Photosensitivity can result in sunburn, rash, blisters, or skin discoloration. Therefore, the nurse should recommend the client to limit exposure to sunlight and avoid tanning beds while taking ciprofloxacin and for several days after finishing the course. The nurse should also suggest the client to wear protective clothing, sunglasses, and sunscreen when outdoors.

Choice A reason: Crushing and mixing the tablets with pudding if you have trouble swallowing the tablets is not an instruction that should be included in the teaching plan, but rather a contraindicated practice that can reduce the effectiveness of ciprofloxacin and increase its side effects. Ciprofloxacin tablets have a special coating that protects them from stomach acid and allows them to dissolve slowly in the intestine. Crushing them will destroy their coating and make them dissolve faster in the stomach. This can cause stomach irritation, nausea, vomiting, diarrhea, or reduced absorption of ciprofloxacin into the bloodstream. Therefore, the nurse should instruct the client to swallow the tablets whole and not chew or crush them.

Choice D reason: Using NSAIDs to relieve mild joint aches and pains caused by the medication is not an instruction that should be included in the teaching plan, but rather a risky behavior that can increase the risk of adverse effects from ciprofloxacin. NSAIDs are anti-inflammatory drugs that can reduce pain, fever, and inflammation. However, NSAIDs can also interact with ciprofloxacin and increase its concentration in the blood. This can lead to toxicity and serious side effects such as seizures, hallucinations, confusion, or liver damage. Therefore, the nurse should caution the client to avoid using NSAIDs while taking ciprofloxacin and consult with their healthcare provider before taking any other medications.