You are instructed to administer 40 mg of methadone (Dolophine) subcutaneously for opioid detoxification. Given that you have a concentration of 30 mg/mL on hand, how much should you draw into the syringe?

Rationale for Choice A:
A shift to the left in the white blood cell (WBC) count indicates an increased presence of immature neutrophils, known as bands. This is a hallmark sign of infection, as the body is rapidly producing and releasing these cells to fight off invading pathogens.
Prompt notification of the primary health care provider is crucial to initiate timely antibiotic therapy, if indicated. Early intervention with appropriate antibiotics can effectively combat the infection, prevent its progression, and potentially avert serious complications.
Delaying antibiotic treatment can allow the infection to worsen, potentially leading to sepsis, septic shock, or other life- threatening conditions.
Rationale for Choice B:
While informing the client about the significance of a shift to the left is important for education and understanding, it does not address the immediate need for medical intervention.
The priority action is to involve the primary health care provider for prompt assessment and potential initiation of antibiotic therapy.
Rationale for Choice C:
Documenting findings and continuing to monitor the client's condition is essential for ongoing assessment and evaluation, but it does not constitute a proactive intervention to address the underlying infection.
Documentation alone does not initiate treatment, and monitoring without intervention risks allowing the infection to progress.
Rationale for Choice D:
Protective isolation is not routinely indicated for clients with a shift to the left in their WBC count unless there is a specific concern for transmission of a highly contagious infection.
The decision to implement protective isolation measures would be based on the client's overall clinical presentation and potential infectious risks, as determined by the primary health care provider.

Choice A rationale:
Weight gain is the most objective and reliable indicator of improved nutritional status in patients with HIV-II and wasting syndrome. It directly reflects an increase in lean body mass, which is essential for restoring physical strength, immune function, and overall health.
A weight gain of 2 lb (1 kg) in a month is considered a clinically significant improvement for this patient population. It demonstrates that the patient is consuming more calories than they are expending, leading to a positive energy balance and tissue growth.
Other assessment findings, such as food intake, food choices, and oral discomfort, can be subjective and influenced by various factors, such as appetite, taste changes, nausea, fatigue, and psychosocial issues. While they provide valuable information about the patient's nutritional status, they do not directly measure the actual improvement in body composition.
Choice B rationale:
Consuming 90% of meals and snacks is a positive sign that the patient is adhering to their dietary recommendations. However, it does not guarantee that they are consuming enough calories to promote weight gain. The patient's individual energy needs and the nutritional content of the meals and snacks must be considered.
Choice C rationale:
Choosing high-protein foods is important for building and repairing tissues, but it does not ensure adequate overall caloric intake. The patient may still be experiencing a calorie deficit if they are not consuming enough total calories, even if they are focusing on protein-rich foods.
Choice D rationale:
Decreased oral discomfort can facilitate better food intake, but it does not directly reflect weight gain or improved nutritional status. The patient may still have challenges with appetite, nausea, or other factors that hinder their ability to consume enough calories.