The healthcare provider prescribes 500 mL of 0.45% normal saline with 100 units regular insulin to infuse at 15 units/hour. The drop factor is 20 gtt/mL. The nurse should regulate the IV to deliver how many gtt/minute? (Enter numerical value only.)

Rationale:

A. Consistently applies TED hose before getting dressed in the morning: TED hose are designed to promote venous return, not arterial circulation. They may actually worsen arterial insufficiency by further reducing peripheral perfusion.

B. Inspects feet daily for any irritation or skin breakdown: Daily foot inspection is essential for diabetes management but does not directly improve arterial circulation or relieve claudication symptoms.

C. Frequently elevates legs throughout the day: Leg elevation reduces venous congestion but may decrease arterial blood flow to the extremities, worsening symptoms of peripheral artery disease.

D. Completely stops cigarette/cigar smoking: Smoking cessation significantly improves arterial circulation by reducing vasoconstriction and atherosclerotic progression, directly addressing the underlying cause of intermittent claudication.

Rationale:

• Ambulates with a walker: Being able to walk, even with assistance, indicates improved muscle control and coordination on the affected side. This shows progress in motor recovery and suggests that blood flow has been restored to motor areas of the brain.
• Tearful sharing of stories: Expressing emotion and recalling events indicate intact cognitive and communicative function. While post-stroke emotional lability can occur, this behavior also shows higher cortical functioning, which supports improved cerebral perfusion after treatment.
• Speaks in short sentences: The ability to form and express language suggests that expressive and receptive language centers in the brain are functioning. Improvement in speech following initial garbling indicates that early ischemic stroke interventions are showing clinical benefits.

Rationale for Incorrect Choices:

• Flaccidity of left arm: Persistent flaccidity implies ongoing neurological deficit and poor motor control on the affected side. This finding suggests that motor recovery has not yet occurred and may indicate continued brain tissue injury.
• Passive range of motion of the left leg: Requiring passive movement assistance reflects impaired voluntary motor control. This does not support improved function or stroke recovery, as it indicates dependence rather than restored movement.
• Fits of laughter: Sudden, inappropriate emotional expressions can signify pseudobulbar affect, a post-stroke complication. While common, it reflects disrupted emotional regulation rather than clinical improvement.
• Angry outbursts: Emotional instability, including irritability and anger, may result from frontal lobe injury. It reflects emotional dysregulation, which can be a lingering or worsening effect of neurological damage, not an indicator of recovery.
• Drinks with repetitive cough: Coughing when drinking signals impaired swallowing reflex and a risk for aspiration. This suggests that brain areas controlling swallowing are still affected, showing unresolved neurological deficits.
• Decorticate posturing: This is a sign of severe brain injury and poor prognosis. It indicates worsening intracranial damage, not a positive response to ischemic stroke treatment.