A nurse is preparing to administer labetalol 40 mg IV to a client. Available is labetalol 5 mg/mL. How many mL should the nurse administer? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

Rationale:

• Parotid glands: Parotid gland enlargement is a typical finding in clients with bulimia nervosa due to repeated episodes of self-induced vomiting. The recurrent stimulation of salivary glands leads to painless swelling, often bilateral, and may also contribute to facial puffiness or a rounded appearance.
• Potassium level: A potassium level of 3.0 mEq/L is low and may result from either bulimia nervosa or anorexia nervosa. In bulimia, this is typically due to purging through vomiting or laxative use; in anorexia, it stems from prolonged restriction, dehydration, and possible diuretic misuse. Both conditions increase the risk of cardiac complications.
• Weight: The client’s weight of 61.8 kg with a BMI of 20.7 falls within the normal range and is more consistent with bulimia nervosa. Individuals with anorexia nervosa usually present with a significantly lower body weight and BMI, typically below 18.5, due to extreme caloric restriction and prolonged starvation.
• Sodium level: A sodium level of 134 mEq/L is slightly low and can occur in both bulimia nervosa and anorexia nervosa. In bulimia, frequent vomiting may cause sodium loss, while in anorexia, hyponatremia can develop from malnutrition, dehydration, or excessive water intake in attempts to suppress appetite or manipulate weight.
• Hand findings: Calluses on the index and middle fingers, known as Russell’s sign, are associated with bulimia nervosa. These result from repeated trauma during induced vomiting episodes, as the hand comes into contact with the teeth. This finding is a classic physical sign of chronic purging behavior.

Rationale:

A. The client is drinking 2.5 L of water per day: Adequate hydration is important during pregnancy to support blood volume, amniotic fluid levels, and kidney function. A fluid intake of 2.5 liters per day is appropriate and does not raise concerns.

B. The client started working in a parking garage 3 months ago: Parking garages may expose individuals to carbon monoxide and other vehicle exhaust fumes, which can pose risks to fetal development. Prolonged exposure to poor air quality warrants further evaluation for potential harm.

C. The client last visited the dentist 4 months ago: Regular dental care is encouraged during pregnancy due to increased risk of gingivitis and periodontal disease. Visiting the dentist 4 months ago is within a normal range and does not signal unsafe behavior.

D. The client is doing 30 min of moderate exercise daily: Moderate exercise is recommended during pregnancy unless contraindicated. It improves circulation, mood, and energy, and supports healthy weight gain and fetal outcomes.