The healthcare provider prescribes heparin 18 units/kg/hr IV for a client who weighs 154 Ibs to prevent deep vein thrombosis (DVT). The premixed IV solution is labeled "Heparin Sodium 20,000 Units in Dextrose 5% in Water (D5W) 500 mL". The nurse should program the infusion pump to deliver how many mL/hr? (Enter numerical value only. If rounding is required, round to the nearest tenth.)

Rationale:
A. Position the client for comfort on the nonoperative side: Repositioning may improve comfort but does not address the possible cause of absent fluctuation in the water seal chamber. This intervention would not determine whether the lung has re-expanded or if there is an obstruction in the system.

B. Clamp the tubing and have the client take deep breaths: Clamping the chest tube is contraindicated unless specifically ordered, as it can cause tension pneumothorax by trapping air in the pleural space. Deep breathing will not identify the cause of the lack of fluctuation safely.

C. Increase the amount of suction on the wall suction: Increasing suction arbitrarily may not correct the problem and could damage lung tissue. The absence of fluctuation may be due to re-expansion of the lung or blockage in the tubing, not inadequate suction strength.

D. Assess the client’s breath sounds on the affected lung: Assessing breath sounds helps determine whether the lung has fully re-expanded or if the chest tube is obstructed. If breath sounds are equal bilaterally and the client shows no respiratory distress, the lack of fluctuation likely indicates lung re-expansion, a positive outcome.

Rationale:
A. Unstable hemodynamics: Performing a thoracentesis in a client with unstable blood pressure or cardiac output increases the risk of circulatory collapse. Fluid removal can further compromise venous return and perfusion, making hemodynamic stability a critical prerequisite for the procedure.

B. Coagulation deficiencies: Clients with coagulopathies, such as low platelet counts or elevated INR, face a high risk of bleeding into the pleural space or chest wall during thoracentesis. Correction of clotting abnormalities is necessary before proceeding to prevent hemothorax or uncontrolled bleeding.

C. Hypertension: Elevated blood pressure alone is not a contraindication for thoracentesis. It may require monitoring and control, but it does not inherently increase procedural risk unless accompanied by other cardiovascular instability.

D. Mechanical ventilation required: Clients on mechanical ventilation can safely undergo thoracentesis when carefully monitored, although it requires expert technique to prevent pneumothorax. The need for mechanical ventilation is not an absolute contraindication.

E. Tracheal deviation: Tracheal deviation is often a sign of mediastinal shift or large pleural effusion, not a reason to avoid thoracentesis. In fact, the procedure may help relieve pressure by removing excess pleural fluid.

F. Infection is incorrect because systemic infection alone is not a strict contraindication; however, infection at the puncture site would be a concern, but this option is too general.