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?

Step 1: Determine the desired dose in mL.

We need to convert the desired dose of 200 mg to mL based on the concentration of the suspension (125 mg/5 mL). We can achieve this using the following proportion:

Desired dose (mg) / Concentration (mg/mL) = Volume (mL) Step 2: Perform the calculation.

Substituting the known values:

200 mg / 125 mg/mL = Volume (mL) Solving for the volume:

Volume = 200 mg / 125 mg/mL

Volume ≈ 1.6 mL

Step 3: Round the answer to a whole number, considering clinical practice.

In medication administration, especially for liquid volumes, doses are typically rounded to a whole number for accuracy and to avoid medication waste. Rounding up to 2 mL would be inaccurate and potentially lead to an overdose. Therefore, we round down to the nearest whole number, which is 1 mL.

Step 4: Adjust the dose based on minimum volume recommendations (Optional).

Some medication suspensions have minimum recommended volumes for accurate dosing, regardless of the calculated dose. Consult the specific medication guidelines to determine if there is a minimum volume requirement. In this case, if the medication guidelines recommend not administering less than 5 mL, then the nurse would administer 5 mL as the minimum safe volume, even though the calculated dose is lower.

Therefore, based on the calculations and considering potential volume minimums, the nurse should administer 8 mL of the phenytoin suspension.

Choice A rationale:
Coughing and deep breathing: These techniques directly promote airway clearance by mobilizing and expelling secretions from the lungs. They are essential for clients with pneumonia, as the buildup of secretions can obstruct the airways and impair gas exchange.
Hydration maintenance: Adequate hydration helps to thin secretions, making them easier to cough up and clear from the lungs. It also helps to prevent dehydration, which can worsen respiratory symptoms.

Choice B rationale:
Keeping the head of the bed elevated: This can help to improve breathing by decreasing the work of breathing and promoting lung expansion. However, it is not the most effective intervention for directly clearing secretions from the lungs.

Choice C rationale:
Preparation for insertion of a tracheostomy tube: This is a more invasive intervention that may be necessary in severe cases of airway obstruction. However, it is not the priority intervention for a client with ineffective airway clearance related to pneumonia.

Choice D rationale:
Providing supplemental oxygen: This can help to improve oxygenation in clients with pneumonia. However, it does not directly address the problem of ineffective airway clearance.