A client receives a prescription for vancomycin 500 mg IV every 8 hours. The medication is provided in "500 mg per 100 ml" of dextrose 5% in water.
To administer the medication over an hour, the nurse should set the infusion pump to deliver how many mL/hr?

Choice A rationale:

Amber urine can be a sign of dehydration, but it is not specific to cholelithiasis with a gallstone lodged in the common bile duct.

While it's important to monitor hydration status in patients with nausea and vomiting, amber urine alone would not be the most urgent finding to report to the healthcare provider in this context.

Choice B rationale:

Belching is a common symptom of gastrointestinal disorders, but it is not specific to cholelithiasis with a gallstone obstruction. It can be caused by various factors, such as swallowing air, eating too quickly, or drinking carbonated beverages.

While belching might be a symptom the nurse documents, it would not be the most concerning finding to report immediately.

Choice C rationale:

Flatulence is another common gastrointestinal symptom that can have various causes, including dietary choices, bacterial fermentation in the intestines, and certain medications.

It is not specific to cholelithiasis with a gallstone obstruction and would not be the most relevant finding to prioritize reporting.

Choice D rationale:

Yellow sclera, also known as jaundice, is a significant finding that strongly suggests cholestasis, which is the obstruction of bile flow.

Bile, a fluid produced by the liver, aids in digestion and gives stool its brownish color.

When bile flow is obstructed, as in the case of a gallstone lodged in the common bile duct, bilirubin (a component of bile) builds up in the bloodstream and tissues, leading to yellowing of the skin and sclera (the whites of the eyes).

This is a crucial finding to report to the healthcare provider because it indicates a worsening of the patient's condition and the need for prompt intervention to address the obstruction.

The most likely diagnosis for this client isB. Pulmonary embolism and postpartum hemorrhage.

Here’s why:

1. Postpartum Hemorrhage:
   • The client has a large amount of lochia rubra, indicating significant blood loss.
   • Hemoglobin and hematocrit levels are low (7.5 g/dL and 22%, respectively), which is consistent with significant blood loss.
   • Symptoms like feeling lightheaded, pale appearance, and cool, clammy skin further support this diagnosis.
2. Pulmonary Embolism:
   • The client is experiencing shortness of breath, using accessory muscles to breathe, and has an oxygen saturation of 88% on room air.
   • Elevated D-dimer levels (1.5 µg/mL) suggest the presence of a clot.
   • Arterial Blood Gas (ABG) results show a low PaO2 (60 mmHg) and a slightly acidic pH (7.32), which can be seen in pulmonary embolism.
   • The client reports a feeling of tightness in her chest and has a rapid heart rate (120 beats per minute), which are also indicative of a pulmonary embolism.