While setting up an infusion of 1 g of medication diluted in 100 mL over 1 hour, the nurse discovers that the electronic pump is unavailable. The manual IV tubing has a drop factor of 15 gtt/mL. What should the manual drip rate be set to deliver the correct infusion?

A. Increase supplemental oxygen and reassess the patient:Restlessness and confusion are classic early clinical manifestations of cerebral hypoxia. Increasing the fraction of inspired oxygen immediately addresses the physiological deficit at the base of Maslow's hierarchy. Reassessment ensures the intervention is effective in improving oxygen saturation and mental status.

B. Apply restraints for patient safety due to restlessness:Restraints are a last resort and are contraindicated if the patient's behavior is caused by a treatable physiological crisis like hypoxia. Restricting movement can increase agitation and further increase oxygen demand. The priority must be treating the underlying cause of the restlessness.

C. Notify the family about the change in mental status:Informing the family is a communication task that follows immediate clinical intervention. It does not address the life-threatening lack of oxygen that is causing the confusion. The patient's physical stability must be managed before administrative or family communication occurs.

D. Document the findings and observe for further deterioration:Passive observation in the presence of early hypoxia allows the patient's condition to worsen into respiratory arrest. Documentation is a legal requirement but should never delay active nursing intervention for an acute physiological change. Immediate action is required to prevent further decline.

A. Increase the dose of the decongestant: Escalating the dosage of a topical sympathomimetic would exacerbate the physiological dependence of the nasal mucosa on the drug. This would worsen rhinitis medicamentosa, a condition where the vasculature remains chronically dilated without the stimulant. Increasing the dose leads to a cycle of progressively severe mucosal edema.

B. Add mucolytics to the treatment regimen: Mucolytics function by breaking disulfide bonds in mucus to decrease its viscosity and facilitate clearance from the respiratory tract. While helpful for clearing secretions, they do not address the underlying localized vasodilation and tissue swelling characteristic of rebound congestion. They provide no mechanism for restoring normal nasal vascular tone.

C. Stop using decongestants and consult the provider: The primary treatment for rhinitis medicamentosa is the immediate cessation of the causative intranasal vasoconstrictor to allow the nasal mucosa to recover. A healthcare provider can then prescribe intranasal corticosteroids to manage the resulting inflammation and transition the patient to a safer therapy. This approach addresses the root cause of the congestion.

D. Switch to antihistamines: Antihistamines are primarily indicated for allergic rhinitis by blocking the H1 receptor-mediated response to allergens. They do not possess the vasoconstrictive properties needed to counteract the profound mucosal engorgement seen in rebound congestion from decongestant overuse. They are ineffective for treating drug-induced nasal vascular dysfunction.