A nurse is preparing to administer 40 mEq of potassium chloride in 500 mL 0.45% NaCl IV to infuse at 20 mEq/hr via central venous access. The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

A.Daily antihypertensive use manages systemic vascular resistance and cardiac output but does not inherently suppress the immune system or impair the primary phases of wound healing. While uncontrolled hypertension can affect overall surgical outcomes, it is not a direct independent risk factor for the colonization of pathogens at the incision site. The nurse should monitor blood pressure stability rather than increased infectious risk.

B.A history of deep vein thrombosis increases the client's risk for venous thromboembolism during the perioperative period due to venous stasis and hypercoagulability. However, the presence of a previous clot does not compromise the skin barrier or the cellular response required to prevent a surgical site infection. Prophylaxis for this client would focus on anticoagulation and mechanical compression rather than antimicrobial stewardship.

C.Age over 65 years old is associated with physiological changes such as decreased tissue perfusion, thinning of the dermal layer, and a naturally declining immune response known as immunosenescence. These factors collectively hinder the body's ability to clear pathogens and synthesize collagen efficiently at the surgical site. The nurse must recognize that older adults have a statistically higher incidence of postoperative infections compared to younger populations.

D.A body mass index of 23 falls within the healthy reference range of 18.5 to 24.9, indicating an appropriate nutritional status and a normal distribution of adipose tissue. Unlike obesity, which impairs blood flow to subcutaneous tissue, or malnutrition, which prevents protein synthesis, a BMI of 23 supports optimal wound healing. This finding actually suggests a lower risk for complications related to surgical site integrity.

A.Depressed mood and psychological distress are common in clients with chronic autoimmune diseases due to physical limitations and the unpredictable nature of flares. While mental health is a significant concern that requires screening and support, it does not indicate acute organ-threatening pathology. The nurse should address this with counseling and potential pharmacotherapy, but it is not the most immediate threat to life.

B.A facial rash, particularly the characteristic malar "butterfly" rash, is a classic diagnostic hallmark of systemic lupus erythematosus resulting from cutaneous inflammation. While it indicates active disease or photosensitivity, it is usually a superficial manifestation that does not represent internal organ failure. Skin changes are common in SLE and generally managed with topical steroids and ultraviolet light protection rather than emergency intervention.

C.Weight loss can occur during SLE flares due to systemic inflammation, decreased appetite, or metabolic changes associated with the autoimmune process. While significant weight changes require nutritional assessment and monitoring, they usually represent a chronic progression rather than an acute clinical emergency. The nurse should document this finding and assess for other signs of systemic involvement, but it is not the highest priority.

D.Decreased urine output is highly concerning in SLE because it may signal the development of lupus nephritis, a severe complication where immune complexes damage the renal glomeruli. This can rapidly progress to acute kidney injury or chronic renal failure if not treated aggressively with immunosuppressants. Because renal involvement is a leading cause of morbidity and mortality in SLE, this symptom demands immediate diagnostic follow-up.