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.)

A. Hearing loss: Alprazolam, a benzodiazepine medication, is not typically associated with hearing loss. Adverse effects related to hearing are not commonly reported with the use of alprazolam.

B. Insomnia: Insomnia, or difficulty falling or staying asleep, is a potential adverse effect of alprazolam. While benzodiazepines like alprazolam are central nervous system depressants and can cause drowsiness, paradoxical reactions such as insomnia may occur in some individuals.

C. Bradycardia: Alprazolam is not known to cause bradycardia. Instead, it may cause mild tachycardia or irregular heart rhythms as potential cardiovascular side effects.

D. Hypertension: Alprazolam is more likely to cause hypotension (low blood pressure) rather than hypertension. Hypotension is a potential adverse effect due to its central nervous system depressant effects, which can lead to relaxation of blood vessels and decreased blood pressure.

Fluid excess, also known as fluid overload or hypervolemia, occurs when there is an excessive volume of fluid in the body. The nurse should assess for signs and symptoms of fluid excess, which include the following:

A. Bounding pulse: A bounding pulse, or a pulse that feels unusually strong and forceful, can be a sign of fluid excess. Increased blood volume leads to increased cardiac output, which can manifest as a bounding pulse.

B. Urine-specific gravity greater than 1.030: Urine-specific gravity greater than 1.030 typically indicates concentrated urine and is more indicative of dehydration rather than fluid excess.

C. Pitting edema: Pitting edema occurs when pressure is applied to the skin, resulting in an indentation or "pit" that persists after the pressure is released. It is a classic sign of fluid excess, indicating fluid accumulation in the interstitial spaces.

D. Swelling at the IV site: Swelling at the IV site may indicate infiltration or phlebitis rather than fluid excess. While fluid excess can lead to generalized swelling, swelling specifically at the IV site may suggest a local issue related to the IV infusion.

E. Crackles upon auscultation: Crackles, also known as rales, are abnormal lung sounds heard upon auscultation and are indicative of fluid accumulation in the lungs, which can occur with fluid excess. Crackles are typically heard in the bases of the lungs and may indicate pulmonary edema.