The nurse is caring for a client who is in heart failure and weighs 176 pounds.

The client is to receive prescribed dobutamine 10 mcg/kg/minute.

The nurse has available 1,000 mg in 250 mL of 0.9% normal saline.

How many mL per hour should the nurse administer to the client?

Round answer to a whole number.

Choice A rationale

Exposure to cold climates does not directly prevent or mitigate symptoms of thalassemia. Thalassemia involves abnormalities in hemoglobin production, leading to anemia. Climate factors do not influence this pathophysiology. The emphasis for management lies in optimizing red blood cell health and addressing anemia-related complications.

Choice B rationale

Increasing oral fluid intake does not have a specific effect on the prevention of thalassemia symptoms. While adequate hydration is essential for overall health, it does not target the underlying genetic causes of hemoglobinopathies, such as mutations in alpha or beta-globin chains.

Choice C rationale

Iron and vitamin B12-rich diets may worsen complications in thalassemia. Individuals with thalassemia, especially those receiving frequent blood transfusions, are at risk of iron overload. B12 supplementation is beneficial only when deficiency exists, but routine intake does not manage thalassemia symptoms.

Choice D rationale

Many medications and substances, such as oxidative drugs, can exacerbate hemolysis or interact with blood transfusion protocols in thalassemia patients. Reviewing these lists helps prevent complications, thereby reducing symptom severity and improving management outcomes.

Choice A rationale

Hemorrhage is not a typical complication of extracorporeal shock wave lithotripsy (ESWL), as it is a non-invasive procedure targeting kidney stones using shock waves. The risk of significant bleeding is minimal, and monitoring focuses more on urinary changes or localized pain rather than hemorrhage.

Choice B rationale

ESWL does not involve surgical incisions, so there is no incision site to monitor for infection. This action is irrelevant to the procedure's mechanism, which uses external shock waves to fragment stones rather than invasive surgical methods.

Choice C rationale

Sand or gravel in the urine is a common finding after ESWL as the procedure fragments kidney stones into smaller particles. These fragments are excreted through the urinary system. Monitoring urine for these particles helps evaluate the procedure's effectiveness and ensure stones are adequately eliminated.

Choice D rationale

Percutaneous nephrostomy tubes are used for urinary drainage but are not a standard component of ESWL. Monitoring for tube obstruction applies to invasive procedures, whereas ESWL focuses on non-invasive stone fragmentation. This action is unrelated to the client's current treatment modality. .