A client is to receive LR 1000 ml over 8 hours. The IV tubing drop rate is 60 gtts/ml. What is the correct rate (gtts/min)? DOCUMENT ANSWER AS: RATE gtts/min (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

A. A 60-year-old woman with cardiac dysrhythmias post myocardial infarction. Her HR is 39 & irregular, BP 147/65: Although her heart rate is low, carvedilol is commonly used post-MI to reduce mortality, especially in patients with dysrhythmias. However, caution is warranted, and dosage adjustments or withholding may be necessary due to bradycardia.

B. A 55-year-old woman with HTN due to renal failure from chronic pyelonephritis. HR 92. BP 145/72: This client has stable vitals, and carvedilol can be safely used to help manage hypertension. Renal impairment requires monitoring, but it is not a contraindication if renal function is closely followed.

C. A 78-year-old man with a history of hyperlipidemia & cardiac dysfunction. He is in 3rd degree heart block. HR 42. BP 92/65: Carvedilol is contraindicated in clients with 2nd or 3rd degree heart block without a functioning pacemaker. It can worsen bradycardia and conduction delays, making its use unsafe in this client without rhythm control support.

D. A 49-year-old male, BMI 36, history of type 2 diabetes & HTN. HR 105, BP 158/92: This client is hypertensive and tachycardic, both of which carvedilol can help manage. Although diabetes requires careful monitoring for hypoglycemia, there is no contraindication in this scenario.

A. vegetative embolization to the kidneys: Infective endocarditis is an infection of the heart valves or the endocardium. Vegetations (clumps of bacteria, fibrin, and platelets) can form on the damaged heart structures. These vegetations are fragile and can break off, forming emboli that travel through the bloodstream to various organs. Embolization to the kidneys can cause renal infarction, leading to sharp flank pain due to ischemia or infarction of kidney tissue and hematuria.

B. hemolysis of red blood cells by hemolytic microorganisms: While some bacteria can cause hemolysis, it is not typically associated with localized flank pain. Hemolysis would present with systemic signs such as jaundice, fatigue, and anemia, not acute flank pain and visible hematuria.

C. septicemia resulting in decreased glomerular blood flow: Septicemia may impair renal perfusion over time but would more likely lead to generalized signs of acute kidney injury, such as oliguria and rising creatinine levels, rather than acute flank pain and hematuria.

D. bacterial infection in the kidneys: Acute pyelonephritis can cause flank pain and hematuria, but in the context of infective endocarditis, embolic events are a more likely and urgent explanation for new-onset symptoms, particularly sharp localized pain.