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

A low-sodium, high-calorie diet is not the priority for immediate management of renal colic. Nutritional changes are addressed as part of long-term care but do not alleviate acute pain and discomfort caused by obstruction or irritation in the urinary tract.

Choice B rationale

Increasing fluid intake of 3 to 4 L/day is beneficial for preventing stone formation and enhancing urinary output, but fluid intake changes alone do not address acute renal colic. The urgency lies in alleviating the pain and promoting ureteral relaxation.

Choice C rationale

Tamsulosin (Flomax) 0.4 mg p.o. daily relaxes smooth muscles in the ureter, aiding stone passage, but does not provide immediate pain relief. It is a supportive measure rather than a first-line intervention during acute renal colic.

Choice D rationale

Morphine sulfate (Morphine) 2 mg IV every 4 hours PRN is the correct choice, as it addresses severe pain due to renal colic by acting directly on opioid receptors to block pain transmission. Pain relief improves the client’s comfort and allows further management strategies.

Choice A rationale

Thrombopoiesis, the process of platelet production, is not typically a direct cause of secondary immune thrombocytopenic purpura. This condition often stems from an underlying immune or viral trigger rather than bone marrow dysfunction.

Choice B rationale

HIV is a recognized cause of secondary ITP due to immune dysregulation and increased platelet destruction. It is essential to test for HIV in clients with newly diagnosed ITP to identify and manage the underlying condition effectively.

Choice C rationale

Hepatitis C virus is a common trigger for secondary ITP due to immune complex formation and platelet destruction. Testing for HCV is crucial for clients with thrombocytopenia to establish a precise etiology and guide treatment.

Choice D rationale

Von Willebrand disease primarily affects von Willebrand factor and is associated with qualitative or quantitative clotting issues rather than platelet destruction or secondary ITP. It is not routinely tested in this context.

Choice E rationale

Hemophilia B involves Factor IX deficiency leading to bleeding disorders but does not relate to immune-mediated platelet destruction. Testing for hemophilia B is irrelevant in clients suspected of secondary ITP.