A nurse is providing teaching to a client who wants to stop smoking and has purchased a transdermal smoking patch. Which of the following information should the nurse provide?

Step 1: Determine the Lidocaine Concentration

• The solution contains 2 grams (2000 mg) of lidocaine in 500 mL.
• To find the amount of lidocaine per mL:
  2000 mg ÷ 500 mL = 4 mg/mL

Step 2: Calculate the Total Dose per Hour

• The prescribed infusion rate is 4 mg per minute.
• In 1 hour (60 minutes), the total dose is:
  4 mg/min × 60 min = 240 mg/hr

Step 3: Determine the Infusion Rate in mL/hr

• Since each mL contains 4 mg of lidocaine:
  240 mg ÷ 4 mg/mL = 60 mL/hr

The nurse should set the IV pump to 60 mL/hr for the continuous IV infusion of lidocaine at a rate of 4 mg/min.

Choice A Reason:
Absence of deep-tendon reflexes is correct. The absence or decrease in deep-tendon reflexes can be a sign of magnesium toxicity. Magnesium sulfate, when given in excessive amounts or in the case of accumulation due to impaired renal function, can lead to muscle weakness, hyporeflexia, and in severe cases, loss of deep-tendon reflexes. Discontinuation of magnesium sulfate and administration of calcium gluconate is warranted in severe cases of magnesium toxicity to counteract its effects.
Choice B Reason:
Report of chills is incorrect. Chills are non-specific symptoms and are not typically associated specifically with magnesium toxicity. They are less indicative of a need for calcium gluconate administration in the context of magnesium sulfate infusion.
Choice C Reason:
Decreased level of consciousness is correct. Severe magnesium toxicity can affect the central nervous system, leading to symptoms like confusion, drowsiness, and eventually decreased level of consciousness. In these cases, discontinuation of magnesium sulfate and administration of calcium gluconate is crucial to counteract the effects of excessive magnesium.
Choice D Reason:
Systolic blood pressure of 130 mm Hg is incorrect. A systolic blood pressure of 130 mm Hg, by itself, is not an indicator of magnesium toxicity that necessitates the administration of calcium gluconate. Blood pressure within this range is not typically a cause for concern related to magnesium sulfate administration.
Choice EReason:
Urine output of 80 mL in 4 hours is incorrect. While decreased urine output might indicate potential renal issues or compromised kidney function, it's not a specific indication for the administration of calcium gluconate in the context of magnesium sulfate infusion. It can signal the need for further assessment but is not a direct sign of magnesium toxicity requiring calcium gluconate administration.