A nurse is teaching a female client who has a new diagnosis of systemic lupus erythematosus (SLE). The nurse should recognize the need for further teaching when the client identifies which of the following as a factor that can exacerbate SLE?

Choice A rationale:
Phenytoin is an anticonvulsant medication that is typically used long-term to control seizures. It is not a medication that can be stopped abruptly, as this can lead to the recurrence of seizures or even status epilepticus, a life-threatening condition characterized by continuous seizure activity.
The client's statement, "I'll be glad when I can stop taking this medicine," indicates a lack of understanding about the long- term nature of phenytoin therapy and the potential risks associated with stopping the medication prematurely.
Further teaching is needed to emphasize the importance of medication adherence and the potential consequences of non- adherence.

Choice B rationale:
Phenytoin can cause gingival hyperplasia (overgrowth of gum tissue), so it is important for clients taking this medication to see a dentist regularly for checkups and cleanings.
The client's statement, "I have made an appointment to see my dentist next week," indicates an understanding of this potential side effect and the need for regular dental care.

Choice C rationale:
Phenytoin has a narrow therapeutic index, meaning that there is a small difference between the effective dose and the toxic dose.
Switching brands of phenytoin can lead to changes in blood levels of the medication, which could potentially result in therapeutic failure or toxicity.
The client's statement, "I know that I cannot switch brands of this medication," indicates an understanding of this important safety consideration.

Choice D rationale:
Phenytoin can interact with many other medications, including over-the-counter medications and herbal supplements.
It is important for clients taking phenytoin to notify their doctor before taking any other medications to avoid potential drug interactions.
The client's statement, "I will notify my doctor before taking any other medications," indicates an understanding of this potential risk.

Choice A rationale:
Losing 2 pounds in 2 weeks is not a significant weight loss and may not be a cause for concern in this context. It's important to monitor weight trends over time, but this isolated statement doesn't necessarily require immediate discussion.
Choice B rationale:

Engaging in physical activity like swimming is generally beneficial for individuals with rheumatoid arthritis. It can help improve joint mobility, reduce pain, and enhance overall well-being. The nurse might encourage the client to discuss any specific concerns or limitations with their healthcare provider, but the activity itself is not alarming.
Choice C rationale:
Taking an antibiotic concurrently with naproxen can potentially increase the risk of adverse effects. Some antibiotics, like those in the fluoroquinolone class (e.g., ciprofloxacin, levofloxacin), can interact with naproxen and increase the risk of tendonitis or tendon rupture. This interaction warrants further discussion to ensure the client is aware of potential risks and to explore alternative medications if necessary.
Choice D rationale:
Using applesauce to facilitate medication intake is a common and acceptable practice. It does not affect the absorption or efficacy of naproxen.