A nurse is preparing to administer lidocaine 2 mg/min by continuous IV infusion to a client. The amount available is lidocaine 400 mg in 100 mL of dextrose 5% in water. 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.)

Rationale for Correct Choices:

• Infection: A low WBC count of 4,100/mm³ indicates a suppressed immune system, which is a complication in HIV. White blood cells play a key role in fighting infections, so a drop below the normal range places the client at increased risk for opportunistic and routine infections.
• WBC count: The client's WBC count has declined from 4,500/mm³ at diagnosis to 4,100/mm³, now falling below the standard range of 5,000–10,000/mm³. This trend suggests worsening immunosuppression, commonly seen in clients with HIV as the virus affects CD4+ T cells, reducing the body’s ability to fight infections.

Rationale for Incorrect Choices:

• Seizures: Seizure risk is usually associated with electrolyte imbalances, especially hyponatremia or hypernatremia. The client’s sodium level is 139 mEq/L, which is within the normal range, indicating that the risk for seizures is not elevated.
• Bleeding: Although the client’s platelet count has slightly decreased from 164,000 to 162,000/mm³, it remains within the normal range of 150,000–400,000/mm³. Significant bleeding risk generally arises when platelet levels fall well below 100,000/mm³.
• Dysrhythmias: The potassium level is 3.8 mEq/L, within the normal range of 3.5–5.0 mEq/L. Abnormal potassium levels, particularly hypo- or hyperkalemia, are key contributors to cardiac dysrhythmias, which are not suggested by the current lab values.
• Renal failure: The client’s BUN is 18 mg/dL, well within the normal range of 10–20 mg/dL. There is no elevation in BUN or signs of impaired kidney function, making renal failure an unlikely concern at this time.
• Platelet count: The platelet count is slightly lower than before but still within normal limits. A count of 162,000/mm³ does not pose a clinical concern for bleeding, and it does not indicate a serious hematologic issue requiring immediate intervention.
• Sodium level: The sodium level is 139 mEq/L, which is normal. It does not contribute to neurological symptoms such as seizures and is not associated with infection risk or other critical conditions in this scenario.
• Potassium level: The potassium level of 3.8 mEq/L is also within normal range. There is no evidence of potassium-related complications such as dysrhythmias or muscle weakness in the current context.
• BUN level: The client's BUN level is within the normal range (18 mg/dL), indicating normal kidney function and not a risk factor for any of the listed conditions.

A. Frothy sputum: Frothy sputum, particularly pink or blood-tinged, is a classic sign of pulmonary edema, which is common in left-sided heart failure. The left side of the heart cannot pump blood effectively, leading to fluid accumulation in the lungs and causing this symptom.

B. Bradycardia: In left-sided heart failure, tachycardia (elevated heart rate) is more commonly seen as the heart tries to compensate for decreased cardiac output, not bradycardia (slow heart rate).

C. Warm skin: In left-sided heart failure, the skin may feel cool and clammy due to poor circulation and reduced cardiac output. Warm skin is not a typical finding in this condition.

D. Jugular vein distention: Jugular vein distention is more indicative of right-sided heart failure, where there is a backup of blood in the venous system. Left-sided heart failure primarily causes symptoms related to pulmonary congestion.