A nurse is preparing to administer lactated Ringer's 100 mL IV over 15 minutes. The nurse should set the IV infusion pump to deliver how many mL/hr? (Round to the nearest whole number.)

Choice A reason: Citalopram, an SSRI, increases serotonin levels, requiring 4-6 weeks to upregulate serotonin receptors and modulate prefrontal-amygdala circuits for mood improvement. Explaining this delay addresses patient expectations, reducing frustration and enhancing adherence by clarifying the neurochemical timeline of antidepressant action.

Choice B reason: Increasing the dose after 4 days is premature, as SSRIs like citalopram require weeks to alter serotonin signaling and neural plasticity. Premature dose escalation risks side effects like serotonin syndrome without addressing the expected therapeutic lag, making it an inappropriate intervention.

Choice C reason: Assessing for improvement after 4 days is unlikely to yield significant findings, as citalopram’s serotonin modulation takes weeks to impact mood via prefrontal cortex changes. This approach may reinforce the patient’s frustration without addressing the neurochemical basis of the delayed response.

Choice D reason: Reassuring effectiveness without explaining the delay is misleading. Citalopram’s action on serotonin pathways requires time for receptor upregulation and neural circuit adaptation. This vague reassurance does not educate the patient on the neurochemical timeline, potentially reducing trust and adherence.

Choice A reason: Blood glucose is not directly affected by valproic acid, which stabilizes mood via GABA enhancement and sodium channel inhibition. Monitoring glucose is irrelevant, as valproic acid’s primary risks involve hepatic and hematologic toxicity, not metabolic glucose dysregulation.

Choice B reason: Urinalysis is not a priority for valproic acid, which primarily risks hepatotoxicity and thrombocytopenia. It enhances GABA and inhibits sodium channels, with no significant renal effects requiring routine urine monitoring, unlike drugs affecting kidney function.

Choice C reason: Weight assessment is relevant for valproic acid due to potential weight gain, but it is not the priority. Hepatotoxicity, driven by valproic acid’s metabolism in the liver, poses a greater risk, necessitating liver function tests to monitor for severe hepatic damage.

Choice D reason: Valproic acid, metabolized by the liver, can cause hepatotoxicity by disrupting mitochondrial function and fatty acid metabolism. Liver function tests monitor transaminases and bilirubin to detect early hepatic damage, critical before initiating treatment to ensure safe use in bipolar disorder.