A nurse is caring for a client with atrial fibrillation. The provider orders a continuous heparin infusion at 24 units/kg/hour. The heparin is available as an IV infusion of 500 mL D5W with 25,000 units of heparin. The client weighs 85 kg. What infusion rate should the nurse program into the electronic infusion device? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

A.Baked chicken breast prepared without salt is a high-protein, low-sodium option that supports the nutritional needs of a client with liver impairment. It provides essential amino acids necessary for albumin synthesis while avoiding the hidden sodium found in processed meats. This choice helps manage the osmotic pressure needed to reduce ascites and peripheral edema without contributing to further fluid volume excess.

B.Spaghetti with tomato sauce, especially if the sauce is commercially prepared, often contains high levels of sodium used as a preservative and flavor enhancer. High sodium intake in clients with hepatic dysfunction triggers the renin-angiotensin-aldosterone system, leading to significant water retention and worsening of portal hypertension. The nurse should advise the client to choose fresh, unprocessed ingredients to maintain a strict low-sodium profile.

C.A bowl of ice cream contains significant amounts of sugar and saturated fats, which can exacerbate underlying metabolic issues or non-alcoholic fatty liver disease. While it may not be as high in sodium as canned goods, it does not provide the lean protein required for hepatic cellular repair and maintenance of oncotic pressure. The nurse should prioritize nutrient-dense meals that specifically address the sodium restriction and protein requirements.

D.Canned soup is one of the most concentrated sources of sodium in the modern diet, often exceeding 800 mg per serving. Consuming such high levels of salt would cause rapid fluid accumulation in a client with liver impairment, potentially leading to respiratory distress or severe abdominal tension from ascites. The nurse must educate the client to avoid canned or highly processed foods to prevent acute fluid overload.

A.Atropine ophthalmic solution, when administered sublingually, acts as an anticholinergic to reduce oropharyngeal secretions and the "death rattle" heard in unresponsive patients. This intervention improves the quality of breathing and reduces the audible gurgling that can be distressing for family members. It is a standard comfort measure used to manage the excessive secretions that the dying patient can no longer clear.

B.Placing ice chips in the mouth frequently is inappropriate for an unresponsive or obtunded patient due to the high risk of aspiration and choking. As the swallowing reflex diminishes during the late stage of dying, oral intake of any kind should be avoided to prevent respiratory complications. The nurse should focus on non-invasive oral hygiene techniques that provide moisture without introducing a fluid bolus into the posterior pharynx.

C.Late-stage dying patients often have their eyes partially open and lose the blink reflex, leading to corneal drying, irritation, and potential ulceration. Applying lubricating ophthalmic drops bilaterally as needed protects the ocular surface and ensures the patient remains comfortable and free from local pain. This is a vital part of providing a dignified and symptom-free environment during the final stages of life.

D.Assisting an unresponsive, dying patient to a chair three times per day is physically taxing and provides no therapeutic benefit during the active dying phase. At this stage, the focus of care shifts entirely from mobility and rehabilitation to maintaining a peaceful and comfortable environment in bed. Frequent repositioning for comfort is appropriate, but forced mobilization into a chair is contraindicated by the patient's physiological status.

E.Swabbing the mouth with moisturizer addresses the xerostomia and dry mucous membranes common in dying patients, while gentle suctioning helps clear secretions that cause gurgling. These actions maintain oral integrity and prevent the discomfort associated with dry, cracked tissues in the mouth. Careful suctioning ensures that the airway remains as clear as possible without being overly invasive or causing trauma to delicate tissues.

F.Administering intravenous fluids like 0.9% sodium chloride at 50 mL/hour is often discouraged in the final stages of dying as it can exacerbate fluid overload. In a patient already experiencing crackles, edema, and labored respirations, IV fluids can worsen pulmonary congestion and peripheral swelling, increasing overall respiratory distress. Dehydration in the dying process is a natural physiological occurrence that may actually provide a mild analgesic effect.