A nurse is preparing to infuse dextrose 5% in 0.45% sodium chloride 500 mL IV bolus over 4 hr. The drop factor of the manual IV tubing is 60 gtt/mL. The nurse should set the IV infusion to deliver how many gtt/min? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

Rationale:

A. Loss of peripheral vision: Loss of peripheral vision is associated with dysfunction of the optic nerve (cranial nerve II), not the vestibulocochlear nerve (cranial nerve VIII).

B. Deviation of the tongue from midline: Deviation of the tongue from the midline indicates dysfunction of the hypoglossal nerve (cranial nerve XII), not the vestibulocochlear nerve.

C. Disequilibrium with movement: The vestibulocochlear nerve (cranial nerve VIII) is responsible for balance and hearing. Impaired function of this nerve can result in disequilibrium or vertigo with movement, which is a typical finding in vestibular dysfunction.

D. Inability to smell: Inability to smell is related to dysfunction of the olfactory nerve (cranial nerve I), not the vestibulocochlear nerve.

Rationale for Correct Choices:

• Antibiotic therapy: The client’s symptoms (flank pain, painful urination, reddish-brown urine), elevated white blood cell count (15,000/mm³), positive nitrites, leukocyte esterase, and blood in the urine suggest a urinary tract infection (UTI) or pyelonephritis. Antibiotics are needed to treat this infection.
• Urinary tract infection: The urinalysis findings of turbid, dark red urine with blood, positive nitrites, and leukocyte esterase, along with symptoms like painful urination, flank pain, and fever, strongly point to a UTI, possibly involving the kidneys.

Rationale for Incorrect Choices:

• Lithotripsy: Lithotripsy is used for kidney stones, but the client’s symptoms don’t suggest kidney stones, as there is no sharp, colicky pain. The symptoms are more aligned with a UTI.
• Indwelling urinary catheter: An indwelling catheter is not needed for this UTI unless there’s urinary retention. The client's main issue is a UTI, and there is no mention of retention or obstruction requiring a catheter.
• Kidney failure: Although BUN and creatinine are elevated, the primary issue is a UTI, not kidney failure. Kidney failure would be characterized by more severe, prolonged renal dysfunction.
• Pneumonia: The symptoms do not suggest pneumonia. The primary symptoms of pneumonia include cough and difficulty breathing, which are not present here. Crackles are more likely due to fluid overload.