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SYSTEMIC LUPUS ERYTHEMATOUS, Exams of Nursing

United States International UniversityNursing

SYSTEMIC LUPUS ERYTHEMATOUS 2026

Typology: Exams

2025/2026

Available from 01/04/2026

ROCKY-B
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SYSTEMIC LUPUS ERYTHEMATOUS
CASE STUDY PART 1
The client is a 32-year-old married woman with three children under 5 years of age. She
saw her healthcare provider 7 months ago with intermittent fatigue, joint pain, low grade
fever, and unintentional weight loss. - Answer -
CASE STUDY PART 2
Her health care provider noted small, patch areas of vitiligo and a scaly rash across her
nose, cheeks, back, and chest at that time. Laboratory studies showed a positive
antinuclear antibody(ANA) titer, positive anti-dsDNA test, positive anti-Sm test, elevated
C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), and decreased C3
and C4 serum complement. Joint x-ray films showed joint swelling without joint erosion.
The client was diagnosed with systemic lupus erythematosus (SLE). Initial treatment
consisted of hydroxychloroquine (Plaquenil), prednisone, and naproxen sodium, and ice
packs. The client responded well, and the steroid was tapered and stopped.She was
told she could follow up every 6 months unless symptoms became acute. She returned
to her job in medical billing at a large healthcare facility - Answer -
1. What is the significance of each of the client's laboratory findings? - Answer -Positive
antinuclear antibody (ANA) titer = the presence of an autoimmune disorder Positive anti-
dsDNAtest = can indicate the presence of systemic lupus erythematous Positive anti-
Sm test-Anti-Sm (Anti-smith) = high indication of systemic lupus erythematous Elevated
C-reactive protein (CRP) andErythrocyte sedimentation rate (ESR) = inflammation
Decreased C3 and C4 serum compliment = presence of inflammation and autoimmune
diseases
What are the key features of Systemic Lupus Erythematosus (SLE)? - Answer -
*****Fatigue or feeling tired often.
• A rash that appears on the face across the nose and cheeks; this is called a malar or
"butterfly" rash
• Round scaly rashes that can appear anywhere on the body
• Sensitivity to the sun that may cause a rash
• Hair loss.
• Sores, which are usually painless, in the nose and mouth (most often on the roof of the
mouth).
• Change of color in the fingers and toes - blue-purplish, white, or red - from cold and
stress
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SYSTEMIC LUPUS ERYTHEMATOUS

CASE STUDY PART 1

The client is a 32-year-old married woman with three children under 5 years of age. She saw her healthcare provider 7 months ago with intermittent fatigue, joint pain, low grade fever, and unintentional weight loss. - Answer - CASE STUDY PART 2 Her health care provider noted small, patch areas of vitiligo and a scaly rash across her nose, cheeks, back, and chest at that time. Laboratory studies showed a positive antinuclear antibody(ANA) titer, positive anti-dsDNA test, positive anti-Sm test, elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), and decreased C and C4 serum complement. Joint x-ray films showed joint swelling without joint erosion. The client was diagnosed with systemic lupus erythematosus (SLE). Initial treatment consisted of hydroxychloroquine (Plaquenil), prednisone, and naproxen sodium, and ice packs. The client responded well, and the steroid was tapered and stopped.She was told she could follow up every 6 months unless symptoms became acute. She returned to her job in medical billing at a large healthcare facility - Answer -

  1. What is the significance of each of the client's laboratory findings? - Answer - Positive antinuclear antibody (ANA) titer = the presence of an autoimmune disorder Positive anti- dsDNAtest = can indicate the presence of systemic lupus erythematous Positive anti- Sm test-Anti-Sm (Anti-smith) = high indication of systemic lupus erythematous Elevated C-reactive protein (CRP) andErythrocyte sedimentation rate (ESR) = inflammation Decreased C3 and C4 serum compliment = presence of inflammation and autoimmune diseases What are the key features of Systemic Lupus Erythematosus (SLE)? - Answer - *****Fatigue or feeling tired often.
  • A rash that appears on the face across the nose and cheeks; this is called a malar or "butterfly" rash
  • Round scaly rashes that can appear anywhere on the body
  • Sensitivity to the sun that may cause a rash
  • Hair loss.
  • Sores, which are usually painless, in the nose and mouth (most often on the roof of the mouth).
  • Change of color in the fingers and toes - blue-purplish, white, or red - from cold and stress

What are the priority collaborative problems for clients with Systemic Lupus Erythematosus (SLE)? - Answer - Fatigue, Pain, Education, temperature, coping skills Educating the patient on increased awareness about her condition, med administration, and maintenance of the skin. CASE STUDY CONTINUED Two years after diagnosis, the client seeks out her health care provider, saying that she has increased fatigue and puffy hands and feet. She reports that she has been working longer hours due to the absence of two co-workers who are on maternity leave. - Answer - Sodium (136 - 144 mEq/L) - 129 mEq/L - LOW Potassium (3.5 - 5.1 mEq/L) - 4.2 mEq/L Chloride (101 - 111 mEq/L) - 119 mEq/L - HIGH Bicarb (22 - 32 mEq/L) - 21 mEq/L - LOW Blood Urea Nitrogen (BUN) (8 - 26 mg/dL) - 34 mg/dL - HIGH Creatinine (0.44 - 1.00 mg/dL) - 2.6 mg/dL - HIGH Glucose (70 - 99 mg/dL) - 123 mg/dL - HIGH Urinaylysis (UA) - Answer - Color - Yellow Turbidity - Cloudy Specific Gravity - 1. pH - 6. Glucose - Trace Ketones - None Protein - 2+ RBCs - 2+ WBCs - 0 Which laboratory findings concern you and why? - Answer - sodium, chloride, BUN, creatinine, glucose, and her UA with proteinuria and hematuria show kidney function issues.

  1. What major complications associated with immunosuppression therapy will the client have to be monitored for?* - Answer - Infection, Bone marrow suppression The client asks about what plasmapheresis does and why it might help her feel better. How would you respond? - Answer - Plasmapheresis - therapeutic intervention that involves removal, return, or exchange of blood plasma or components. Plasma contains inflammatory antibodies and other immunologically active substances. CASE STUDY PROGRESS The Red Cross comes to the unit and completes the plasmapheresis. One hour later the UAP reports the client's vital signs to you. BP 80/43 mmHg Pulse rate 118 beats/min Respiratory rate 18 breaths/min Temperature 97.2 °F (36.2° C) - Answer - Based on these vital signs, what could be the cause and why? - Answer - Plasmapheresis and dehydration, hypovolemic, hypotensive The nurse assesses the client. What all should be included in the assessment? - Answer - resp status (lung sounds), Cardiac status - rhythm, rate, chest pain, VS, cap refill, skin turgor, skin integrity, reports of dizziness, that patient is returning from plasmapheresis. The client is complaining of dizziness and is slightly diaphoretic but denies any headache, nausea, or paresthesia. She also denies chest pain currently.
  2. The health care provider needs to be notified of the client's status. Using SBAR, what should thenurse report to the provider? - Answer - S: just returned from plasmapheresis and is hypotensive and tachy B: Admitted for pericarditis- given steroids, cyclophosphamide therapy and plasmapheresis A: BP 80/42, HR 118, c/o dizziness, diaphoretic R: IV fluid bolus and pressors to raise BP What would the nurse anticipate the care of this client will include over the next 2 to 3 hours? - Answer - Stabilizing BP with fluids/vasopressors .Continue to assess neuro status and contact provider if there are any changes Keep patient in bed as much as possible (low BP = fall risk) Monitor VS What outcome criteria would support that the client's condition is stabilizing? - Answer - Stable VS - BP and HR

Decreased pain and dizziness A&O x 4 Lab values improve The nurse notes that the client's husband is visiting her. Upon entering the room to ask whether they have any questions, the husband states, "I have tried to tell her that she cannot go back to work. Sure, we need the money, but the kids and I need her more. I'm afraid this lupus has weakened her whole body and it will kill her if she goes back to work. Is that right?" How should the nurse respond to his concerns? - Answer - Clarify what is implied: "It sounds like you are really worried about your wife's health." Explain tha tlupus can have a significant impact on quality of life, including the ability to work. However, she overall can maintain a high quality of life with a good support system What psychosocial priorities should be considered at this time? - Answer - Refer to resources, counseling, support groups Family-centered care Identify limitations in her every daylife Recognition and management plan for her disability CASE STUDY OUTCOME The client's condition stabilizes with fluids and plasmapheresis, and she can be discharged home. Withthe addition of cyclophosphamide to her regimen, her condition improves, and she experiences nofurther episodes of lupus nephritis or pericarditis. Her husband and she decide that she is not going toreturn to work so she can focus on her health and family - Answer - What education priorities need to be taught before discharge? - Answer - Medication regimen When to call the doctor vs when to call 911 Coping skills S/S of infection due to immunosuppressant therapy What was learned from this case study that you will incorporate into your practice? - Answer - Educating patients in regards to how important follow up appointments are, even if things are going well. Also, ensure they can identify acute symptoms and understand when they should seek help.