LUPUS NCLEX PRACTICE QUESTIONS AND ANSWERS 2024-2025 WITH COMPLETE SOLUTION RATED A+, Exams of Nursing

Download LUPUS NCLEX PRACTICE QUESTIONS AND ANSWERS 2024-2025 WITH COMPLETE SOLUTION RATED A+ and more Exams Nursing in PDF only on Docsity!

LUPUS NCLEX PRACTICE QUESTIONS

AND ANSWERS 2024 - 2025 WITH

COMPLETE SOLUTION

1. A 26-year-old woman has been diagnosed with early systemic lupus erythematosus (SLE) involving her joints. In teaching the patient about the disease, the nurse includes the information that SLE is a(n):

A. Hereditary disorder of women but usually does not show clinical symptoms unless a woman becomes pregnant.

B. Autoimmune disease of women in which antibodies are formed that destroy all nucleated cells in the body.

C. Disorder of immune function, but it is extremely variable in its course, and there is no way to predict its progression.

D. Disease that causes production of antibodies that bind with cellular estrogen receptors, causing an inflammatory response. - 1. Answer: C

Rationale: SLE has an unpredictable course, even with appropriate treatment. Women are more at risk for SLE, but it is not confined exclusively to women. Clinical symptoms may worsen during pregnancy but are not confined to pregnancy or the perinatal period. All nucleated cells are not destroyed by the antinuclear antibodies. The inflammation in SLE is not caused by antibody binding to cellular estrogen receptors.

2. A patient with an acute exacerbation of systemic lupus erythematosus (SLE) is hospitalized with incapacitating fatigue, acute hand and wrist pain, and proteinuria. The health care provider prescribes prednisone (Deltasone) 40 mg twice daily. Which nursing action should be included in the plan of care?

A. Institute seizure precautions.

B. Reorient to time and place PRN.

C. Monitor intake and output.

D. Place on cardiac monitor. - 2. Answer: C

Rationale: Lupus nephritis is a common complication of SLE, and when the patient is taking corticosteroids, it is especially important to monitor renal function. There is

no indication that the patient is experiencing any nervous system or cardiac problems with the SLE.

3. A patient with systemic lupus erythematosus (SLE) who has a facial rash and alopecia tells the nurse, "I hate the way I look! I never go anyplace except here to the health clinic." An appropriate nursing diagnosis for the patient is:

A. Activity intolerance related to fatigue and inactivity.

B. Impaired skin integrity related to itching and skin sloughing.

C. Social isolation related to embarrassment about the effects of SLE.

D. Impaired social interaction related to lack of social skills. - 3. Answer: C

Rationale: The patient's statement about not going anyplace because of hating the way he or she looks supports the diagnosis of social isolation because of embarrassment about the effects of the SLE. Activity intolerance is a possible problem for patients with SLE, but the information about this patient does not support this as a diagnosis. The rash with SLE is nonpruritic. There is no evidence of lack of social skills for this patient.

4. A patient with polyarthralgia with joint swelling and pain is being evaluated for systemic lupus erythematosus (SLE). The nurse knows that the serum test result that is the most specific for SLE is the presence of:

A. Rheumatoid factor.

B. Anti-Smith antibody (Anti-Sm).

C. Antinuclear antibody (ANA).

D. Lupus erythematosus (LE) cell prep. - 4. Answer: B

Rationale: The anti-Sm is antibody found almost exclusively in SLE. The other blood tests are also used in screening but are not as specific to SLE.

5. Following instruction for a patient with newly diagnosed systemic lupus erythematosus (SLE), the nurse determines that teaching about the disease has been effective when the patient says:

A. "I should expect to have a low fever all the time with this disease."

B. "I need to restrict my exposure to sunlight to prevent an acute onset of symptoms."

C. "I should try to ignore my symptoms as much as possible and have a positive outlook."

D. "I can expect a temporary improvement in my symptoms if I become pregnant."

• 5. Answer: B

Rationale: Sun exposure is associated with SLE exacerbation, and patients should use sunscreen with an SPF of at least 15 and stay out of the sun between 11:00 AM and 3:00 PM. Low-grade fever may occur with an exacerbation but should not be expected all the time. A positive attitude may decrease the incidence of SLE exacerbations, but patients are taught to self-monitor for symptoms that might indicate changes in the disease process. Symptoms may worsen during pregnancy and especially during the postpartum period.

6. A 19-year-old patient who is taking azathioprine (Imuran) for systemic lupus erythematosus has a check-up before leaving home for college. The health care provider writes all of these orders. Which one should the nurse question?

A. Naproxen (Aleve) 200 mg BID

B. Give measles-mumps-rubella (MMR) immunization

C. Draw anti-DNA titer

D. Famotidine (Pepcid) 20 mg daily - 6. Answer: B

Rationale: Live virus vaccines, such as rubella, are contraindicated in a patient taking immunosuppressive drugs. The other orders are appropriate for the patient.

7. A client is suspected of having systemic lupus erythematous. The nurse monitors the client, knowing that which of the following is one of the initial characteristic sign of systemic lupus erythematous?

A. Weight gain

B. Subnormal temperature

C. Elevated red blood cell count

D. Rash on the face across the bridge of the nose - 7. Answer: D

Rationale: Skin lesions or rash on the face across the bridge of the nose and on the cheeks is an initial characteristic sign of systemic lupus erythematosus (SLE). Fever and weight loss may also occur. Anemia is most likely to occur later in SLE.

8. The nurse is assigned to care for a client with systemic lupus erythematosus (SLE). The nurse plans care knowing that this disorder is:

A. A local rash that occurs as a result of allergy

B. A disease caused by overexposure to sunlight

C. An inflammatory disease of collagen contained in connective tissue

D. A disease caused by the continuous release of histamine in the body - 8. Answer: C

An inflammatory disease of collagen contained in connective tissue

Test-Taking Strategy:

Use the process of elimination. Eliminate option 1 because SLE is a systemic disorder, not a local one. Next eliminate option 2 because of its similarity to option

1. From the remaining options, select option 3 because of its systemic characteristic. If you are unfamiliar with this disorder, review its characteristics.
2. The nurse is assigned to care for a client admitted to the hospital with a diagnosis of systemic lupus erythematosus (SLE). The nurse reviews the health care provider's prescriptions. Which of the following medications would the nurse expect to be prescribed?

A. Antibiotic

B. Antidiarrheal

C. Corticosteroid

D. Opioid analgesic - 9. Answer: C

Rationale: Treatment of SLE is based on the systems involved and symptoms. Treatment normally consists of anti-inflammatory drugs, corticosteroids, and immunosuppressants. The incorrect options are not standard components of medication therapy for this disorder.

10. A nurse is collecting data on a client who complains of fatigue, weakness, malaise, muscle pain, joint pain at multiple sites, anorexia, and photosensitivity. Systematic lupus erythematosus (SLE) is suspected. The nurse further checks for which of the following that is also indicative of the presence of SLE?

A. Emboli

B. Ascites

C. Two hemoglobin S genes

D. Butterfly rash on cheeks and bridge of nose - 10. Answer: D

Rationale: SLE is a chronic inflammatory disease that affects multiple body systems. A butterfly rash on the cheeks and on the bridge of the nose is a classic sign of SLE. Option 3 is found in sickle cell anemia. Options 1 and 2 may be found in many conditions but are not associated with SLE.

11. Which client is at the highest risk for systemic lupus erythematous (SLE)?

A. An Asian male

B. A white female

C. An African-American male

D. An African-American female - 11. Answer: D

An African-American female

12. The nurse monitors a patient to have Systemic Lupus Erythematosus. Which of the following symptoms is characteristic of this diagnosis?

A. Increased T-cell count

B. Scaley, inflamed rash on shoulders, neck, and face

C. Swelling of the extremities

D. Decreased erythrocyte sedimentation rate (ESR) - 12. Answer: B

Scaley, inflamed rash on shoulders, neck, and face

13. In teaching a patient with SLE about the disorder, the nurse knows that the pathophysiology of SLE includes:

A. Circulating immune complexes formed from IgG autoantibodies reacting with IgG

B. An autoimmune T-cell reaction that results in destruction of the deep dermal skin layer

C. Immunologic dysfunction leading to chronic inflammation in the cartilage and muscles

D. The production of a variety of autoantibodies directed against components of the cell nucleus - 13. Answer: D

Rationale: Systemic lupus erythematosus (SLE) is characterized by the production of many autoantibodies against nucleic acids (e.g., single-and double-stranded DNA), erythrocytes, coagulation proteins, lymphocytes, platelets, and many other self- proteins. Autoimmune reactions characteristically are directed against constituents of the cell nucleus (e.g., antinuclear antibodies [ANAs]), particularly DNA. Circulating immune complexes containing antibody against DNA are deposited in the basement membranes of capillaries in the kidneys, heart, skin, brain, and joints. Complement is activated, and inflammation occurs. The overaggressive antibody response is also related to activation of B and T cells. The specific manifestations of SLE depend on which cell types or organs are involved. SLE is a type III hypersensitivity response.

14. A female patient's complex symptomatology over the past year has culminated in a diagnosis of systemic lupus erythematosus (SLE). Which of the patient's following statements demonstrates the need for further teaching about the disease?

A. "I'll try my best to stay out of the sun this summer."

B. "I know that I probably have a high chance of getting arthritis."

C. "I'm hoping that surgery will be an option for me in the future."

D. "I understand that I'm going to be vulnerable to getting infections." - 14. Answer: C

"I'm hoping that surgery will be an option for me in the future."

Rationale: SLE carries an increased risk of infection, sun damage, and arthritis. Surgery is not a key treatment modality for SLE.

15. The pathophysiology of systemic lupus erthematosus (SLE) is characterized by:

A. Destruction of nucleic acids and other self-proteins by autoantibodies

B. Overproduction of collagen that disrupts the functioning of internal organs

C. Formation of abnormal IgG that attaches to cellular antigens, activating complement

D. Increased activity of T-suppressor cells with B-cell hypoactivity, resulting in an immunodeficiency - 15. Answer: A

Destruction of nucleic acids and other self-proteins by autoantibodies

16. A patient with newly diagnosed SLE asks the nurse how the disease will affect her life. The best response by the nurse is:

A. You can plan to have a near-normal life since SLE rarely causes death

B. It is difficult to tell because to disease is so variable in its severity and progression

C. Life span is shortened somewhat in people with SLE, but the disease can be controlled with long-term use of corticosteroids

D. Most people with SLE have alternating periods of remissions and exacerbations with rapid progression to permanent organ damage - 16. Answer: B

It is difficult to tell because to disease is so variable in its severity and progression

17. During an acute exacerbation, a patient with SLE is treated with corticosteroids. The nurse would expect the steroids to begin to be tapered when serum laboratory results indicate:

A. Increased RBCs

B. Decreased ESR

C. Decreased anti-DNA

D. Increased complement - 17. Answer: C

Decreased anti-DNA

18. Teaching that the nurse will plan for the patient with SLE includes:

A. Ways to avoid exposure to sunlight

B. Increasing dietary protein and carbohydrate intake

C. The necessity of genetic counseling before planning a family

D. The use of no pharmacologic pain interventions instead of analgesics - 18. Answer: A

Ways to avoid exposure to sunlight

The nurse is preparing a presentation on systemic lupus erythematosus (SLE). Which statement should the nurse include? (Select all that apply.)

A. The etiology is known to be linked to environmental factors.

B. Manifestations can be mild to fatal, with remissions and exacerbations.

C. The immune complex deposits trigger an inflammatory response.

D. SLE is a result of deposition of antigen-antibody complexes in connective tissues.

E. The inflammatory response leads to anaphylactic shock. - B. Manifestations can be mild to fatal, with remissions and exacerbations.

C. The immune complex deposits trigger an inflammatory response.

D. SLE is a result of deposition of antigen-antibody complexes in connective tissues.

The pathophysiology of systemic lupus erythematosus is a result of the formation of

antigen-antibody immunocomplexes that are deposited in the connective tissue and trigger an inflammatory response. The manifestations of the disease can be mild to fatal, and remissions are followed by exacerbations. The inflammatory response leads to tissue damage but not anaphylactic shock (allergic reaction). Although the exact etiology of SLE is unknown, genetic, ethnic, environmental, and hormonal factors play a role in its development.

The nurse is assessing a client with systemic lupus erythematosus (SLE). Which clinical manifestation should the nurse expect to observe? (Select all that apply.)

A. Red butterfly rash on the face

B. Alopecia

C. Psoriatic lesions

D. Painful or swollen joints

E. Leg and eye edema - A. Red butterfly rash on the face

B. Alopecia

D. Painful or swollen joints

E. Leg and eye edema

Rationale: Painful swollen joints, alopecia, red butterfly rash on the face, and leg and eye edema are all characteristics of SLE. Psoriatic lesions are caused by psoriasis, which is an autoimmune disease characterized by patches of abnormal skin.

The nurse is assessing a client with systemic lupus erythematosus (SLE). Which manifestation should the nurse recognize as a result of inflammation? (Select all that apply.)

A. Cough

B. Malaise

C. Maculopapular rash

D. Joint pain

E. Fever - B. Malaise

C. Maculopapular rash

D. Joint pain

E. Fever

In SLE, the immunocomplexes that are deposited in the connective tissue trigger an inflammatory response. Joint pain, fever, malaise, and maculopapular rash are all signs of the inflammation that result from local tissue damage. A cough is a sign of infection, not of inflammation resulting from tissue damage.

A client diagnosed with systemic lupus erythematosus (SLE) is experiencing pulmonary interstitial fibrosis. Which classification of lupus should the nurse suspect?

A. Systemic

B. Drug-induced

C. Discoid

D. Cutaneous - A. Systemic

The classification of lupus the client is experiencing is systemic. There are three major classifications of SLE: discoid or cutaneous, systemic, and drug-induced.

Systemic lupus involves one or more of these systems: cardiovascular, central nervous, hematologic, kidneys, lungs, and musculoskeletal. Cutaneous or discoid lupus is limited to the skin. Many drugs can cause a syndrome that mimics lupus (drug-induced lupus).

The nurse is caring for a client with systemic lupus erythematosus (SLE). Which system should the nurse consider as being most affected by the formation of immune complexes and tissue damage?

A. Cardiac

B. Integumentary

C. Respiratory

D. Renal - D. Renal

When the SLE autoantibodies react with their corresponding antigen, they form immune complexes, which are then deposited in the connective tissue of blood vessels, lymphatic vessels, and other tissues. These deposits trigger an inflammatory response that leads to local tissue damage. The kidneys are a frequent site of complex deposition and damage. The other systems include cardiac, respiratory, and integumentary.

The laboratory results of a client with systemic lupus erythematosus (SLE) indicates anemia. Which collaborative therapy should the nurse anticipate?

A. Performing a splenectomy

B. Treating the underlying cause

C. Administering corticosteroids

D. Administering erythropoietin - D. Administering erythropoietin

For the client with anemia, medications such as erythropoietin may be given to stimulate red blood cell production. A splenectomy and the administration of corticosteroids are clinical therapies to treat thrombocytopenia. The underlying cause of the anemia is SLE. The disease cannot be cured, but the symptoms can be managed.

A client with a history of systemic lupus erythematosus (SLE) anxiously states, "My chest hurts when I lie down. I think it is from coughing so much. Please sit me up." Which condition should the nurse first suspect?

A.

Anemia

B.

Myocardial infarction

C.

Pericarditis

D.

Thrombocytopenia - C. Pericarditis

A client diagnosed with SLE is at risk for pericarditis. Clinical manifestations of pericarditis include chest pain radiating to the back, relieved by sitting forward and worsening when lying down, and a dry cough. Electrocardiogram (ECG) findings in pericarditis are an ST elevation and PR depression. Although clients with SLE are prone to thrombocytopenia and anemia, the clinical presentation is not consistent with these conditions. While a myocardial infarction should be considered, the symptoms combined with the client's history should first lead the nurse to suspect pericarditis.

The nurse is caring for a pregnant client with systemic lupus erythematosus (SLE). Which neonatal complication related to maternal lupus should the nurse anticipate the fetus to be tested for during the second trimester of pregnancy?

A.

Liver involvement

B.

Congenital heart block (CHB)

C.

Anemia

D.

Renal anomalies - B. Congenital heart block (CHB)

Congenital heart block (CHB) may occur in the fetus of a mother diagnosed with SLE. Fetal echocardiography may be used to assess for CHB in the second trimester of pregnancy. The prognosis for CHB varies, depending on when the congenital heart defect is detected. With treatment, early CHB may be reversible. However, late CHB could require the insertion of a pacemaker at the time of delivery. Fetal anemia, renal anomalies, and liver involvement are not tested for in the second trimester of pregnancy.

An older adult client is experiencing an acute episode of systemic lupus erythematosus (SLE). Which primary concern should the nurse consider when administering newly prescribed medications?

A.

Neurological function

B.

Cardiovascular function

C.

Respiratory function

D.

Renal function - D. Renal function

Treatment for the older adult client is the same regardless of the age at onset of the disease. In addition to taking into consideration that older adults may be taking multiple medications, these individuals may have decreased renal function. Pharmacokinetics and drug-to-drug interactions need to be considered prior to the initiation of medications commonly used to treat SLE. Respiratory, neurological, and cardiovascular function are important, but the renal system remains a primary concern.

The nurse is teaching a client newly diagnosed with systemic lupus erythematosus (SLE). Which information should the nurse include in the client's teaching?

A.

Using high-dose birth control pills

B.

Avoiding large crowds

C.

Using only acetaminophen for pain relief

D.

Increasing daily sun exposure - B. Avoiding large crowds

The client should be advised to avoid large crowds to decrease exposure to infection. Instruct the client to limit sun exposure and to use sunscreen with an SPF rating of 15 or higher when outdoors. The client should take aspirin or ibuprofen for pain, but should monitor for side effects of bleeding. The client should be encouraged to use contraception to prevent pregnancy, because the prescribed drugs for treatment may increase the risk for birth defects

The nurse is reviewing medications ordered for a newly admitted female client with systemic lupus erythematosus (SLE). Which medication order should the nurse question?

A.

Corticosteroid

B.

Oral contraceptive

C.

Immunosuppressive

D.

Antineoplastic - B. Oral contraceptive

High-dose corticosteroids, immunosuppressants, and antineoplastic drugs are all used for the treatment of acute SLE. Caution needs to be taken with the use of oral contraceptives because estrogen triggers the symptoms of SLE.

The nurse is caring for a client with systemic lupus erythematosus (SLE) who presents with pain and discomfort. Which treatment option should the nurse anticipate? (Select all that apply.)

A.

Proper nutrition

B.

Corticosteroids

C.

NSAIDs

D.

Increasing sun exposure

E.

Moderate exercise - B. Corticosteroids

E. Moderate exercise

C. NSAIDs

NSAIDs are used to treat inflammation and pain in clients with SLE. A prescribed exercise plan can alleviate pain but must be balanced with adequate rest. Low-dose corticosteroids are used to reduce pain and inflammation in SLE. Improving nutrition promotes a well-balanced diet, improving overall health in clients, but does not specifically impact pain. Some medications that are used to treat SLE cause sun sensitivity; therefore, clients are advised to decrease the amount of time in the sun and to use sunscreen and other forms of sun protection when outdoors.

Which laboratory test is used in the diagnosis of systemic lupus erythematosus (SLE)? (Select all that apply.)

A.

Triglyceride levels

B.

Erythrocyte sedimentation rate (ESR)

C.

Urinalysis

D.

Complete blood count (CBC)

E.

Anti-DNA antibody testing - B.

Erythrocyte sedimentation rate (ESR)

C.

Urinalysis

D.

Complete blood count (CBC)

E.

Anti-DNA antibody testing

The laboratory tests that are used in the diagnosis of SLE are anti-DNA antibody testing to detect antibodies that occur in SLE, erythrocyte sedimentation rate (ESR) to detect elevation related to SLE, serum complement levels to detect depletion by antigen-antibody complexes of SLE, complete blood count (CBC) to detect anemia and overall pancytopenia, and urinalysis for abnormal traces of blood and protein indicating kidney dysfunction related to SLE. Triglycerides are measured in the diagnosis of cardiovascular diseases like atherosclerosis.

The nurse is teaching a new colleague the effects of drugs used for clients with systemic lupus erythematosus (SLE). Which statement by the colleague indicates the need for further teaching?

A.

"When the client is on aspirin therapy, I should monitor for renal toxicity."

B.

"Corticosteroid therapy can cause cushingoid effects."

C.

"If a cytotoxic agent is prescribed, infection may occur."

D.

"Thrombosis prevention is a positive side effect with aspirin therapy." - A. "When the client is on aspirin therapy, I should monitor for renal toxicity."

Aspirin therapy may cause liver toxicity and hepatitis, not renal toxicity. Corticosteroid therapy can cause cushingoid effects. Aspirin is particularly beneficial for clients with SLE because its antiplatelet effects help to prevent thrombosis. Cytotoxic drugs can cause immunosuppression, placing the client at risk for infection, malignancy, and bone marrow depression.

A client diagnosed with systemic lupus erythematosus (SLE) presents with fatigue, joint pain, oral ulcers, and a red rash over the face and upper trunk. Which collaborative therapy should the nurse expect to implement?

A.

Surgical drainage of affected joints

B.

Antibiotic therapy

C.

Physical therapy to improve mobility

D.

Corticosteroid therapy - D. Corticosteroid therapy

The nurse would expect corticosteroid therapy to be ordered. SLE is an autoimmune disorder, and corticosteroids and rest are the first-line treatment. It is a disorder of the muscles, so the nurse would not expect surgical drainage of the joints. It is autoimmune, not infective, in origin, so the nurse would not expect antibiotic therapy as a first-line treatment unless the client also has signs of infection. Also, a priority treatment is rest, so the nurse would not expect physical therapy to be ordered to improve mobility.

The nurse is planning care for an adolescent client with systemic lupus erythematosus (SLE). Which nursing diagnosis is a special consideration for this client?

A.

Fluid Volume: Imbalanced, Risk for

B.

Infection, Risk for

C.

Memory, Impaired

D.

Body Image, Disturbed - D. Body Image, Disturbed

The adolescent client with SLE needs special consideration for body image disturbance, such as hair loss and moon face, resulting from the effects of medication for treatment of SLE. A risk for infection and increased risk of fluid volume imbalance apply to all clients with SLE. Impaired memory is not a typical clinical manifestation of SLE. (NANDA-I ©2014)

In a community setting, the nurse is providing care to a client who was recently diagnosed with systemic lupus erythematosus (SLE). Which is the goal of care for this client? (Select all that apply.)

A.

Reducing pain

B.

Preventing infections

C.

Maintaining skin integrity

D.

Reducing inflammation

E.

Limiting fluid intake - A.

Reducing pain

B.

Preventing infections

C.

Maintaining skin integrity

D.

Reducing inflammation

The treatment goals for clients with SLE are to reduce pain, reduce inflammation, prevent infections, maintain skin integrity, prevent exacerbations, and improve coping skills. Fluid and nutrition should be balanced while taking kidney function into consideration.

The nurse is admitting a client with systemic lupus erythematosus (SLE) for an upper respiratory infection. Which nursing goal is the priority?

A.

The client demonstrates proper hand hygiene.

B.

The client can verbalize the impact of the diagnosis to the healthcare provider.

C.

The client can verbalize the importance of oral care.

D.

The client can verbalize skin care needs to reduce the risk of altered skin integrity.

• A. The client demonstrates proper hand hygiene.

The client demonstrating proper hand hygiene will reduce the risk of infection. Alterations in skin integrity, including those in the oral cavity, can increase the risk of acute exacerbation of SLE. It is important for the client diagnosed with SLE to be able to verbalize the impact of the disease to the healthcare provider in order to address the client's psychosocial well-being.

Next Question

The nurse is providing teaching for a client diagnosed with systemic lupus erythematosus (SLE) experiencing alterations in skin integrity. Which client statement indicates effective teaching?

A.

"I will use fluorescent lighting."

B.

"I will apply sunscreen immediately prior to going outdoors."

C.

"I will limit the use of cosmetics."

D.

"I will cover the lesions on my head with a wig." - C. "I will limit the use of cosmetics."

Cosmetics can irritate the skin and increase the risk of integumentary symptoms. It is important for the client's safety to use adequate lighting to prevent injury, and to specifically avoid fluorescent lighting. Fluorescent lighting has been linked to exacerbation of SLE. If the client experiences alopecia, it is important that a wig is avoided when skin integrity is impaired. The client should apply sunscreen 30 minutes prior to going out in the sun.

The nurse is caring for a client with exacerbation of systemic lupus erythematosus (SLE). Which statement by the nurse is accurate?

A.

"The client is at risk for weight loss."

B.

"The client is at risk for a micronutrient deficiency."

C.

"The client is at risk for a macronutrient deficiency."

D.

"The client is at risk for weight gain." - D. "The client is at risk for weight gain."

The client is at risk for weight gain associated with the treatment involving steroids and a decreased activity level during exacerbation of the disease. The client is not at risk for weight loss, micronutrient deficiency, or macronutrient deficiency unless the GI tract is compromised.

The client enters the outpatient clinic and states to the triage nurse, "I think I have the flu. I'm so tired, I have no appetite, and everything hurts." The triage nurse assesses the client and finds a butterfly rash over the bridge of nose and on the cheeks. Which diagnosis does the nurse expect?

A) Systemic lupus erythematosus

B) Fibromyalgia

C) Lyme disease

D) Gout - Answer: A

Explanation: A) The rash over the nose and cheeks is sometimes called a butterfly rash and is classic for the diagnosis of systemic lupus erythematosus (SLE), although not every client diagnosed with this disorder will have this rash. While fibromyalgia, Lyme's disease, and gout share some symptoms of SLE, they do not cause a rash over the nose and cheeks.

A female client asks the nurse if there are any conditions that can exacerbate systemic lupus erythematosus (SLE). Which is the best nurse response?

A) "Conditions that cause hypotension can often exacerbate SLE."

B) "GI upset is often associated with SLE exacerbation."

C) "Pregnancy is often associated with an SLE exacerbation."

D) "Fever is a known trigger for an SLE exacerbation." - Answer: C

Explanation: A) Pregnancy can be associated with an exacerbation of SLE due to the rise of estrogen levels. Hypotension, fever, and GI upset are not factors that risk exacerbation of SLE.

The nurse is providing health education to a diverse group at a neighborhood community center. Why does the nurse plan to include signs and symptoms of systemic lupus erythematosus (SLE)?

A) The neighborhood is composed of many young female children.

B) The audience has asked the nurse to include the information.

C) The audience is mainly composed of Caucasian women.

D) The audience is mainly females of Asian-American descent. - Answer: D

Explanation: A) Among women who are of child-bearing age, SLE is seen in more African-Americans, Hispanics, and Asian-Americans than Caucasians. There is no evidence that the audience asked for the information.

The nurse is caring for a client who is hospitalized due to an exacerbation of systemic lupus erythematosus (SLE). The nurse is reviewing the client's lab work and finds the white blood cell count (WBC) is shifted to the left. Based on this information, which is a priority nursing diagnosis for this client?

A) Ineffective Protection

B) Ineffective Health Maintenance

C) Ineffective Individual Coping

D) Risk for Impaired Skin Integrity - Answer: A

Explanation: A) All identified diagnoses are appropriate for a client with SLE. However, the shift to the left in the WBC count indicates an increased risk for infection. A shift to the left in a WBC differential is indicative of a large number of immature cells, suggesting infection, and is therefore the priority for the client with the diagnosis Ineffective Protection.

A client with SLE is being treated with immunosuppressant drugs and corticosteroids. Which precautions should the nurse provide this client?

Select all that apply.

A) Avoid large crowds.

B) Don't get a flu shot.

C) Use contraception to prevent pregnancy

D) Refrain from taking aspirin or ibuprofen.

E) Report signs of infection to the physician. - Answer: A, C, D, E

Explanation: A) Crowds may increase exposure to infection. Annual influenza vaccination is recommended but clients with significant immunosuppression should not receive live vaccines. Immunosuppressive drugs may increase the risk of birth defects. Aspirin or ibuprofen may increase the risk of bleeding. Chills, fever, sore throat, fatigue, or malaise should be reported.

A nurse is caring for a client with systemic lupus erythematosus (SLE). The client begins to cry and tells the nurse that she is afraid that her skin will be disfigured with lesions. Which intervention does the nurse plan to teach this client to minimize skin infections associated with SLE?

Select all that apply.

A) Use sunscreen with an SPF of 15 or greater.

B) Remain indoors on sunny days.

C) Avoid swimming in a pool or the ocean.

D) Avoid sun exposure between 10:00 a.m. and 3:00 p.m.

E) Decrease sun exposure between 3:00 p.m. and 5:00 p.m. - Answer: A, D

Explanation: A) The nurse teaches the client to live a normal life with a few extra precautions. There is a relationship between sun exposure and infection, so the client is taught to use sunscreen with an SPF of at least 15 and to avoid the sun between 10:00 a.m. and 3:00 p.m. The client may swim but should reapply sunscreen after swimming. The client does not need to stay indoors on sunny days or to decrease sun exposure between 3:00 p.m. and 5:00 p.m.

The nurse is caring for a client who has been diagnosed with discoid lupus erythematosus. The nurse is collaborating with the client to set goals for the nursing plan of care. What is an appropriate goal for this client?

A) Work through the stages of death and dying.

B) Comply 100% of the time with a sun protection plan.

C) Gain weight to within 10 pounds of normal for height.

D) Report pain no higher than four on a scale of 1-10. - Answer: B

Explanation: A) Discoid lupus erythematosus is an autoimmune disorder of the skin, so the client must protect against the sun to avoid skin cancers and other complications. It is not fatal, is not related to weight, and is rarely painful unless complications arise.

The nurse is planning care for an adolescent client who has systemic lupus erythematosus (SLE). The nurse knows that the treatment plan implemented by the healthcare team is appropriate for the situation when the client:

A) Refuses to attend school.

B) Does not want to attend any social functions.

C) Discusses skin changes with the healthcare personnel.

D) Discusses skin changes with a good friend. - Answer: D

Explanation: A) Peer interaction is important to teens. Being able to discuss the physical changes related to SLE with a friend indicates acceptance of the change in body image. Refusing to go to school or attend social functions indicates nonacceptance of the changes to body image. Discussing changes only with healthcare personnel does not indicate the teen has adjusted to the body image changes.

The nurse is providing care for a newly married woman with systemic lupus erythematosus (SLE). Which client statement indicates plan of care understanding?

A) "I will take birth control pills while I am taking cytotoxic medications."

B) "I do not need to contact the doctor if I develop a fever or rash."

C) "I plan to go to the movies this weekend so that I get out of the house."

D) "I can take ibuprofen as indicated for pain." - Answer: A

Explanation: A) Treatment for SLE can include cytotoxic drugs. The client is taught to avoid pregnancy by using contraceptives, as these drugs can cause birth defects. The client is taught to avoid crowds, as they are potential sources of infection. Client with SLE should contact their primary care providers should signs of infection occur, as the immune system is compromised. Aspirin and ibuprofen can cause bleeding and should be taken with extreme care.

A nurse is caring for a client with systemic lupus erythematous (SLE) who is taking hydroxychloroquine (Plaquenil). The nurse understands that the primary concern with this drug is:

A) Pulmonary fibrosis.

B) Cushingoid effects.

C) Retinal toxicity.

D) Renal toxicity. - Answer: C

Explanation: A) Hydroxychloroquine (Plaquenil) is an antimalarial drug used in SLE to reduce the frequency of acute episodes of SLE. The primary concern with Plaquenil is retinal toxicity and possible irreversible blindness. Cushingoid effects are a concern with corticosteroid therapy. Pulmonary fibrosis is a potential adverse effect of cyclophosphamide, not Plaquenil. Renal toxicity is not the primary concern with Plaquenil.

A nurse caring for a client with SLE on immunosuppressive therapy understands that careful teaching is required to make sure both clients and family members understand appropriate precautions against the threat of infection. Teaching points should include:

Select all that apply.

A) Avoid large crowds and situations that increase exposure to infection.

B) Report difficulty breathing or cough to the physician if taking cyclophosphamide.

C) Use ibuprofen instead of acetaminophen if fever develops.

D) Women may develop heavy menstrual bleeding during therapy. - Answer: A, B

Explanation: A) The nurse should teach the client and family regarding avoiding large crowds and situations that increase exposure to infection and to report difficulty breathing or cough. The client should report a fever if it develops, and

ibuprofen should not be used, as this may increase the risk for bleeding. Women may have an absence of menstruation, not heavy bleeding, during therapy.