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MS3 > Chapter 69: SLE > Flashcards

Chapter 69: SLE Flashcards

1
Q

A 35-year-old woman of African American descent presents to the clinic with complaints of fatigue, joint pain, and a rash on her cheeks and nose. She reports that these symptoms have been recurring for several years, with periods of improvement and worsening. Laboratory tests reveal anemia and elevated antinuclear antibodies (ANA). What is the most likely diagnosis for this patient?

a. Rheumatoid arthritis
b. Systemic lupus erythematosus (SLE)
c. Osteoarthritis
d. Fibromyalgia

A

b. Systemic lupus erythematosus (SLE)

Rationale: The patient’s symptoms (fatigue, joint pain, and characteristic malar rash) along with laboratory findings (anemia and elevated ANA) are indicative of SLE. SLE is known for its chronic, unpredictable course with periods of remission and exacerbation, and it more commonly affects women, particularly those of African American descent.

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2
Q

Which of the following systems are commonly affected by systemic lupus erythematosus (SLE)?

a. Cardiovascular, endocrine, and gastrointestinal
b. Skin, joints, and serous membranes
c. Muscular, respiratory, and reproductive
d. Skeletal, digestive, and urinary

A

b. Skin, joints, and serous membranes

Rationale: SLE typically affects the skin, joints, and serous membranes (pleura, pericardium). It is a multisystem inflammatory autoimmune disease, meaning it can affect multiple organ systems, but the skin, joints, and serous membranes are commonly involved.

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3
Q

What factors contribute to the development of systemic lupus erythematosus (SLE)? (SATA)

a. Genetic factors
b. Hormonal factors
c. Environmental factors
d. Immune factors

A

all of the choices are correct

Rationale: SLE is a complex disorder of multifactorial origin, resulting from interactions among genetic, hormonal, environmental, and immune factors. Each of these factors plays a role in the development and progression of the disease.

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4
Q

Which population is more likely to develop systemic lupus erythematosus (SLE) compared to Whites?

a. European Americans
b. Middle Eastern Americans
c. Native Americans
d. Pacific Islanders

A

c. Native Americans

Rationale: SLE is more prevalent in certain ethnic groups, including Blacks, Asian Americans, Hispanics, Native Americans, and Pacific Islanders, compared to Whites. These populations are more likely to develop SLE.

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5
Q

A 28-year-old Hispanic woman is diagnosed with systemic lupus erythematosus (SLE). She asks about the typical age range when SLE symptoms begin to appear. What is the appropriate response?

a. Between 10 to 30 years
b. Between 15 to 45 years
c. Between 20 to 50 years
d. Between 25 to 55 years

A

b. Between 15 to 45 years

Rationale: Most people with SLE develop the disease between ages 15 to 45 years. This age range is typical for the onset of SLE symptoms.

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6
Q

Which of the following systems are often affected by systemic lupus erythematosus (SLE)? (SATA)

a. Renal system
b. Hematologic system
c. Neurologic system
d. Endocrine system

A

a. Renal system
b. Hematologic system
c. Neurologic system

Rationale: SLE often affects the renal, hematologic, and neurologic systems. These systems can experience various complications and manifestations due to the autoimmune nature of the disease.

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7
Q

A 30-year-old woman presents to the clinic with complaints of fatigue, joint pain, and photosensitivity. She has a family history of systemic lupus erythematosus (SLE). Genetic testing reveals the presence of HLA-DR2 and HLA-DR3 genes. What role do these genes play in the development of SLE?

a. They directly cause SLE.
b. They are protective against SLE.
c. They have no known association with SLE.
d. They are associated with an increased risk of developing SLE.

A

d. They are associated with an increased risk of developing SLE.

Rationale: Multiple genes from the HLA complex, including HLA-DR2 and HLA-DR3, are associated with an increased risk of developing SLE. These genetic factors contribute to the susceptibility to the disease.

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8
Q

Which hormonal factors are known to play a role in the onset or worsening of systemic lupus erythematosus (SLE)?

a. Start of menses, oral contraceptive use, and pregnancy
b. Menopause and hormone replacement therapy
c. Androgen therapy
d. Corticosteroid use

A

a. Start of menses, oral contraceptive use, and pregnancy

Rationale: Hormones play a significant role in SLE. The onset or worsening of disease symptoms may occur after the start of menses, with oral contraceptive use, and during and after pregnancy.

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9
Q

Which environmental factors can contribute to the development of systemic lupus erythematosus (SLE)? (SATA)

a. Sun or ultraviolet light exposure
b. Exposure to silica dust
c. Dietary habits
d. Exposure to some chemicals and toxins

A

a. Sun or ultraviolet light exposure
b. Exposure to silica dust
d. Exposure to some chemicals and toxins

Rationale: Environmental factors that contribute to SLE include sun or ultraviolet light exposure, exposure to silica dust, and exposure to some chemicals and toxins. These factors can trigger or exacerbate the disease.

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10
Q

Which infection is known to stimulate immune hyperactivity and potentially contribute to systemic lupus erythematosus (SLE)?

a. Hepatitis B virus
b. Epstein Barr virus
c. Human papillomavirus (HPV)
d. Influenza virus

A

b. Epstein Barr virus

Rationale: Infections, including the Epstein Barr virus, may stimulate immune hyperactivity and potentially contribute to the development of SLE.

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11
Q

A patient with a long history of tetracycline use presents with symptoms suggestive of systemic lupus erythematosus (SLE). What type of SLE might this patient be experiencing?

a. Drug-induced SLE
b. Genetic SLE
c. Environmental SLE
d. Idiopathic SLE

A

a. Drug-induced SLE

Rationale: Drug-induced SLE can occur months to years after continuous therapy with a causative drug, such as tetracycline. This condition should not be confused with drug side effects.

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12
Q

Which of the following autoantibodies are commonly made by the body in systemic lupus erythematosus (SLE)?

a. Antibodies against viral antigens
b. Antibodies against bacterial proteins
c. Antibodies against dietary proteins
d. Antibodies against nucleic acids

A

d. Antibodies against nucleic acids

Rationale: In SLE, the body makes various autoantibodies against nucleic acids, such as single- and double-stranded DNA, as well as against erythrocytes, coagulation proteins, lymphocytes, platelets, and many other self-proteins.

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13
Q

What factors are involved in the autoimmune reactions in systemic lupus erythematosus (SLE)? (SATA)

a. Antinuclear antibodies (ANA)
b. Antibodies against viral proteins
c. B and T cell activation
d. Antibodies against dietary antigens

A

a. Antinuclear antibodies (ANA)
c. B and T cell activation

Rationale: Autoimmune reactions in SLE involve antinuclear antibodies (ANA) that are directed against elements of the cell nucleus, especially DNA. Overaggressive autoimmune responses are related to the activation of B and T cells.

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14
Q

In which systems do circulating immune complexes with antibodies against DNA commonly deposit in systemic lupus erythematosus (SLE)?

a. Muscular and endocrine systems
b. Digestive and respiratory systems
c. Kidneys, heart, skin, brain, and joints
d. Reproductive and urinary systems

A

c. Kidneys, heart, skin, brain, and joints

Rationale: Circulating immune complexes with antibodies against DNA are deposited in the basement membranes of capillaries in the kidneys, heart, skin, brain, and joints. These complexes trigger inflammation and tissue destruction.

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15
Q

A 25-year-old woman presents with fatigue, joint pain, and a malar rash. Laboratory tests reveal the presence of antinuclear antibodies (ANA). What is the role of these antibodies in systemic lupus erythematosus (SLE)?

a. They target dietary proteins.

b. They are directed against elements of the cell nucleus, especially DNA.

c. They are directed against viral antigens.

d. They target bacterial proteins.

A

b. They are directed against elements of the cell nucleus, especially DNA.

Rationale: Antinuclear antibodies (ANA) are directed against elements of the cell nucleus, especially DNA, in SLE. These antibodies play a significant role in the autoimmune reactions associated with the disease.

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16
Q

Which type of hypersensitivity response is systemic lupus erythematosus (SLE) classified as?

a. Type I hypersensitivity
b. Type II hypersensitivity
c. Type III hypersensitivity
d. Type IV hypersensitivity

A

c. Type III hypersensitivity

Rationale: SLE is classified as a type III hypersensitivity response. This type of hypersensitivity involves the formation of immune complexes that trigger inflammation and tissue damage.

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17
Q

What are the potential triggers for drug-induced systemic lupus erythematosus (SLE)? (SATA)

a. Sulfa drugs
b. Diuretics
c. Tetracycline
d. Penicillin

A

all of the choices are correct

Rationale: Drug triggers for SLE include those that make a person more sensitive to the sun (e.g., sulfa drugs, diuretics, tetracycline) and penicillin or similar antibiotics. These drugs can contribute to the development of drug-induced SLE.

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18
Q

A patient with SLE is found to have immune complexes deposited in the kidneys. What is the primary consequence of this deposition?

a. Inflammation and tissue destruction
b. Kidney stones
c. Increased urine output
d. Decreased kidney function

A

a. Inflammation and tissue destruction

Rationale: The deposition of immune complexes in the kidneys triggers inflammation that causes tissue destruction. This can lead to decreased kidney function and other complications.

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19
Q

A 40-year-old patient presents with signs of systemic lupus erythematosus (SLE) and reports long-term exposure to silica dust in an industrial setting. What role might silica dust have played in the development of SLE in this patient?

a. Silica dust acts as a genetic factor.
b. Silica dust acts as a hormonal factor.
c. Silica dust is a known environmental trigger for SLE.
d. Silica dust has no known association with SLE.

A

c. Silica dust is a known environmental trigger for SLE.

Rationale: Exposure to silica dust in agricultural or industrial settings is a known environmental factor that can contribute to the development of SLE.

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20
Q

A 25-year-old woman presents with fatigue, fever, weight loss, joint pain, and a rash. She is diagnosed with systemic lupus erythematosus (SLE). The patient asks what body systems and tissues could potentially be affected by SLE. What is the best response?

a. Only the skin and joints
b. Only the kidneys and nervous tissue
c. Any organ and tissue, including skin, muscle, lungs, heart, nervous tissue, and kidneys
d. Only the cardiovascular and respiratory systems

A

c. Any organ and tissue, including skin, muscle, lungs, heart, nervous tissue, and kidneys

Rationale: SLE is a multisystem autoimmune disease that can affect any organ or tissue. Commonly involved tissues are the skin and muscle, lining of the lungs, heart, nervous tissue, and kidneys. General symptoms such as fever, weight loss, joint pain, and fatigue may precede exacerbations.

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21
Q

Which of the following statements is true regarding the progression of systemic lupus erythematosus (SLE)?

a. SLE follows a predictable pattern of progression
b. SLE is exclusively a mild disorder
c. SLE ranges from a mild disorder to a rapidly progressive disease
d. SLE only affects the skin and joints

A

c. SLE ranges from a mild disorder to a rapidly progressive disease

Rationale: The severity of SLE varies widely. It can range from a mild disorder to a rapidly progressive disease affecting many body systems. There is no characteristic pattern in the progression of SLE.

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22
Q

Which general symptoms may precede worsened disease activity in patients with systemic lupus erythematosus (SLE)? (SATA)

a. Fever
b. Weight loss
c. Joint pain
d. Fatigue

A

all of the choices are correct

Rationale: General symptoms that may precede worsened disease activity in SLE include fever, weight loss, joint pain, and fatigue. These symptoms can indicate a flare or exacerbation of the disease.

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23
Q

Which of the following tissues are commonly involved in systemic lupus erythematosus (SLE)?

a. Skin, muscle, lungs, heart, nervous tissue, and kidneys
b. Eyes, ears, liver, and pancreas
c. Teeth, nails, hair, and gastrointestinal tract
d. Bones, cartilage, spleen, and lymph nodes

A

a. Skin, muscle, lungs, heart, nervous tissue, and kidneys

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24
Q

Which type of skin lesion is most likely to develop in patients with chronic cutaneous lupus erythematosus (CCLE)?

a. Vesicular lesions
b. Discoid lesions
c. Pustular lesions
d. Bullous lesions

A

b. Discoid lesions

Rationale: Patients with CCLE commonly have discoid lesions, which are round and coin-shaped. These lesions typically appear on the scalp and face.

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25
Q

A patient with systemic lupus erythematosus (SLE) presents with a red, ring-shaped lesion on their back. The lesion does not scar or itch, and it is not thick and scaly. What type of lupus is this patient most likely experiencing?

a. Subacute cutaneous lupus erythematosus (SCLE)
b. Chronic cutaneous lupus erythematosus (CCLE)
c. Acute cutaneous lupus erythematosus
d. Drug-induced lupus erythematosus

A

a. Subacute cutaneous lupus erythematosus (SCLE)

Rationale: SCLE is characterized by red, ring-shaped lesions that do not scar or itch and are not thick and scaly. These features match the description provided for the patient.

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26
Q

Which of the following are common skin manifestations in systemic lupus erythematosus (SLE)? (SATA)

a. Malar rash
b. Alopecia
c. Oral ulcers
d. Thick, scaly lesions

A

a. Malar rash
b. Alopecia
c. Oral ulcers

Rationale: Common skin manifestations in SLE include the malar rash (butterfly rash), alopecia, and oral ulcers. Thick, scaly lesions are not typical of SLE.

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27
Q

What percentage of patients with chronic cutaneous lupus erythematosus (CCLE) later develop lupus in other organ systems?

a. 5%
b. 10%
c. 20%
d. 25%

A

b. 10%

Rationale: About 10% of patients with CCLE later develop lupus in other organ systems.

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28
Q

A 26-year-old woman with systemic lupus erythematosus (SLE) reports experiencing hair loss. She wants to know if her hair will grow back. What is the best response?

a. “Your hair loss is permanent and will not grow back.”
b. “Hair loss can occur in SLE, but it may grow back during remission.”
c. “You will need medication to help your hair grow back.”
d. “Hair loss is uncommon in SLE, so it may be due to another cause.”

A

b. “Hair loss can occur in SLE, but it may grow back during remission.”

Rationale: Alopecia is common in SLE, and hair may grow back during remission. However, hair loss may be permanent over lesions.

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29
Q

What is the most common form of acute cutaneous lupus erythematosus?

a. Discoid lesions
b. Vesicular lesions
c. Butterfly rash over the cheeks and bridge of the nose
d. Bullous lesions

A

c. Butterfly rash over the cheeks and bridge of the nose

Rationale: The most common form of acute cutaneous lupus erythematosus is the butterfly rash (malar rash) over the cheeks and bridge of the nose, which looks like a sunburn.

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30
Q

Which factors can contribute to severe skin reactions in systemic lupus erythematosus (SLE)? (SATA)

a. Sun exposure
b. Genetic predisposition
c. Stress
d. Penicillin use

A

a. Sun exposure
c. Stress
d. Penicillin use

Rationale: Severe skin reactions in SLE can be triggered by sun exposure, stress, and the use of certain drugs such as penicillin. Genetic predisposition, while a contributing factor to SLE in general, is not specifically linked to severe skin reactions.

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31
Q

A patient with systemic lupus erythematosus (SLE) presents with dry, scaly, and atrophied scalp along with hair loss. What is the most likely cause of these symptoms?

a. Psoriasis
b. Chronic cutaneous lupus erythematosus (CCLE)
c. Tinea capitis
d. Seborrheic dermatitis

A

b. Chronic cutaneous lupus erythematosus (CCLE)

Rationale: The symptoms of a dry, scaly, and atrophied scalp along with hair loss are consistent with chronic cutaneous lupus erythematosus (CCLE).

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32
Q

Which of the following symptoms is often the first sign of arthritis in patients with systemic lupus erythematosus (SLE)?

a. Erythema
b. Pain in multiple joints with morning stiffness
c. Muscle weakness
d. Fever

A

b. Pain in multiple joints with morning stiffness

Rationale: Pain in multiple joints (polyarthralgia) with morning stiffness is often the first symptom of arthritis in patients with SLE. This symptom may precede the onset of multisystem disease by many years.

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33
Q

What are some common deformities associated with SLE-related arthritis? (SATA)

a. Swan neck deformity of the fingers
b. Ulnar deviation
c. Subluxation with joint laxity
d. Kyphosis

A

a. Swan neck deformity of the fingers
b. Ulnar deviation
c. Subluxation with joint laxity

Rationale: Common deformities associated with SLE-related arthritis include swan neck deformity of the fingers, ulnar deviation, and subluxation with joint laxity. Kyphosis is not typically associated with SLE-related arthritis.

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34
Q

What type of arthritis is typically seen in patients with systemic lupus erythematosus (SLE)?

a. Erosive arthritis
b. Nonerosive arthritis
c. Septic arthritis
d. Osteoarthritis

A

b. Nonerosive arthritis

Rationale: SLE-related arthritis is often nonerosive, meaning it does not cause erosion of the bone. This distinguishes it from other types of arthritis like rheumatoid arthritis, which is erosive.

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35
Q

A patient with SLE complains of joint pain, diffuse swelling, and stiffness. Which of the following complications is this patient at increased risk for?

a. Bone loss and fracture
b. Muscle hypertrophy
c. Hypercalcemia
d. Anemia

A

a. Bone loss and fracture

Rationale: Patients with SLE have an increased risk for bone loss and fracture due to the chronic inflammation and possible use of corticosteroids in their treatment regimen.

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36
Q

What is a common early symptom of musculoskeletal problems in patients with systemic lupus erythematosus (SLE)?

a. Weight gain
b. Skin rash
c. Polyarthralgia
d. Hypertension

A

c. Polyarthralgia

Rationale: Polyarthralgia, or pain in multiple joints, is a common early symptom of musculoskeletal problems in patients with SLE. It often presents with morning stiffness and may precede other multisystem symptoms.

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37
Q

A patient with SLE presents with deformities in their fingers that include a swan neck appearance. What is the most likely diagnosis for this patient’s condition?

a. Rheumatoid arthritis
b. Osteoarthritis
c. SLE-related arthritis
d. Psoriatic arthritis

A

c. SLE-related arthritis

Rationale: The deformities described, including the swan neck appearance of the fingers, are characteristic of SLE-related arthritis. These deformities occur due to joint and muscle pain, stiffness, and nonerosive arthritis associated with SLE.

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38
Q

Which of the following symptoms in a patient with systemic lupus erythematosus (SLE) suggests the presence of lung disease?

a. Bradycardia and chest pain
b. Tachypnea and cough
c. Hypertension and fever
d. Edema and night sweats

A

b. Tachypnea and cough

Rationale: Tachypnea (rapid breathing) and cough suggest the presence of lung disease in patients with SLE. These symptoms indicate possible involvement of the respiratory system.

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39
Q

What cardiac complications may arise in systemic lupus erythematosus (SLE) due to fibrosis of the sinoatrial and atrioventricular nodes?

a. Dysrhythmias
b. Bradycardia
c. Atrial fibrillation
d. Ventricular tachycardia

A

a. Dysrhythmias

Rationale: Fibrosis of the sinoatrial and atrioventricular nodes in patients with SLE can lead to dysrhythmias. Dysrhythmias are indicative of abnormal heart rhythms and can be a sign of advanced disease.

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40
Q

A patient with SLE presents with inflammation of the heart lining, causing chest pain. Which of the following conditions is the patient most likely experiencing?

a. Pericarditis
b. Myocarditis
c. Endocarditis
d. Pleurisy

A

a. Pericarditis

Rationale: Inflammation of the heart lining is referred to as pericarditis, which can cause chest pain and other symptoms. It is one of the possible cardiac complications in patients with SLE.

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41
Q

What is a leading cause of death among patients with systemic lupus erythematosus (SLE) related to cardiac involvement?

a. Myocardial infarction
b. Pulmonary embolism
c. Dysrhythmias due to fibrosis of the sinoatrial and atrioventricular nodes
d. Congestive heart failure

A

c. Dysrhythmias due to fibrosis of the sinoatrial and atrioventricular nodes

Rationale: Dysrhythmias due to fibrosis of the sinoatrial and atrioventricular nodes show advanced disease and are a leading cause of death among patients with SLE.

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42
Q

A patient with SLE is being treated with corticosteroids and presents with high blood pressure and elevated cholesterol levels. What complications should be carefully monitored in this patient?

a. Hyperglycemia and weight loss
b. Hypotension and bradycardia
c. Hypertension and hypercholesterolemia
d. Anemia and leukopenia

A

c. Hypertension and hypercholesterolemia

Rationale: Hypertension and hypercholesterolemia from steroid use need aggressive treatment and careful monitoring in patients with SLE. These complications can increase the risk of cardiovascular disease.

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43
Q

Which of the following conditions are associated with secondary antiphospholipid syndrome (APS) in patients with SLE? (SATA)

a. Stroke
b. Gangrene
c. Heart attack
d. Deep vein thrombosis

A

a. Stroke
b. Gangrene
c. Heart attack

Rationale: Secondary antiphospholipid syndrome (APS) is a coagulation disorder that causes clots in the arteries and veins, increasing the risk for stroke, gangrene, and heart attack.

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44
Q

What is the main complication of hypertension and hypercholesterolemia in patients with SLE that requires careful monitoring?

a. Congestive heart failure
b. Peripheral neuropathy
c. Increased risk for cardiovascular disease
d. Renal failure

A

c. Increased risk for cardiovascular disease

Rationale: Hypertension and hypercholesterolemia in patients with SLE increase the risk for cardiovascular disease, making it important to manage these conditions aggressively and monitor the patient closely.

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45
Q

A 28-year-old female with a 3-year history of systemic lupus erythematosus (SLE) presents to the clinic with complaints of swelling in her lower extremities and foamy urine. The nurse reviews her laboratory results and notes 3+ proteinuria and an increased serum creatinine level. Based on the patient’s history and symptoms, which of the following interventions is the priority?

a. Initiate fluid restriction to prevent fluid overload
b. Educate the patient about dietary potassium restrictions
c. Prepare the patient for a possible renal biopsy
d. Discontinue all immunosuppressive therapy to prevent further renal damage

A

c. Prepare the patient for a possible renal biopsy

Rationale: In SLE, renal involvement can manifest as lupus nephritis, which varies in severity from mild proteinuria to rapidly progressive glomerulonephritis. A renal biopsy helps determine the extent of renal damage and guides treatment. While fluid and dietary management may be important, they do not replace the need for a definitive diagnosis through biopsy. Immunosuppressive therapy is crucial in slowing disease progression and should not be discontinued abruptly.

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46
Q

A patient with lupus nephritis is prescribed belimumab (Benlysta). Which statement by the patient indicates a need for further teaching?

a. “This medication helps reduce autoantibody levels and inflammation in my kidneys.”

b. “I should avoid live vaccines while taking this medication.”

c. “I may begin to feel better within a few days of starting the medication.”

d. “I should report any signs of infection, such as fever or chills, to my provider immediately.”

A

c. “I may begin to feel better within a few days of starting the medication.”

Rationale: Belimumab (Benlysta) is a human monoclonal antibody that reduces autoantibody levels and controls disease activity in lupus nephritis. However, it takes weeks to months for the full therapeutic effects to become evident. Patients should avoid live vaccines due to immunosuppression and be vigilant about infections, as the medication increases the risk of opportunistic infections.

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47
Q

A nurse is reviewing the medication list for a patient with lupus nephritis. Which of the following medications should the nurse question?

a. Azathioprine
b. Voclosporin
c. Prednisone
d. Ibuprofen

A

d. Ibuprofen

Rationale: NSAIDs like ibuprofen can worsen renal function in patients with lupus nephritis by reducing renal blood flow and contributing to nephrotoxicity. Immunosuppressive agents such as azathioprine, voclosporin, and corticosteroids like prednisone are commonly used to manage lupus nephritis and preserve renal function.

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48
Q

A 34-year-old woman with SLE is diagnosed with rapidly progressive glomerulonephritis. The provider prescribes high-dose IV methylprednisolone. What is the primary rationale for this treatment?

a. To provide immediate immunosuppression to reduce renal inflammation
b. To prevent osteoporosis and bone loss associated with lupus
c. To enhance renal perfusion and promote diuresis
d. To counteract potential drug interactions with belimumab

A

a. To provide immediate immunosuppression to reduce renal inflammation

Rationale: High-dose IV methylprednisolone is often used in lupus nephritis to rapidly reduce inflammation and immune-mediated damage in the kidneys. It is particularly beneficial in severe cases or when cytotoxic agents have not yet taken effect. It does not directly enhance renal perfusion or prevent osteoporosis.

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49
Q

A patient with lupus nephritis is started on voclosporin (Lupkynis). Which assessment finding would require immediate intervention?

a. Blood glucose level of 180 mg/dL
b. Blood pressure of 150/90 mmHg
c. Potassium level of 3.6 mEq/L
d. White blood cell count of 7,000/mm³

A

b. Blood pressure of 150/90 mmHg

Rationale: Voclosporin is a calcineurin inhibitor that can cause hypertension. Uncontrolled hypertension can accelerate renal damage in lupus nephritis, making it a priority concern. While hyperglycemia is a possible side effect, the blood glucose level provided is not immediately critical. The potassium and WBC levels are within normal limits.

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50
Q

A patient with lupus nephritis asks why they need immunosuppressive therapy. Which response by the nurse is most appropriate?

a. “These medications prevent infections that can worsen your kidney disease.”
b. “They help reduce your immune system’s attack on your kidneys.”
c. “They help your kidneys produce more urine to prevent fluid overload.”
d. “They work by reversing the kidney damage caused by lupus.”

A

b. “They help reduce your immune system’s attack on your kidneys.”

Rationale: In lupus nephritis, the immune system mistakenly attacks kidney tissue, leading to inflammation and damage. Immunosuppressive agents slow this process and help preserve kidney function. They do not directly prevent infections, increase urine output, or reverse kidney damage.

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51
Q

A nurse is providing discharge teaching to a patient with lupus nephritis who is prescribed azathioprine. Which statement by the patient indicates an understanding of the teaching?

a. “I should take this medication with food to decrease nausea.”
b. “I can stop taking this medication if I feel better.”
c. “I should limit my fluid intake to prevent fluid retention.”
d. “This medication will help repair my kidneys completely.”

A

a. “I should take this medication with food to decrease nausea.”

Rationale: Azathioprine can cause gastrointestinal discomfort, so taking it with food may help. It should not be discontinued abruptly, fluid intake should not be restricted unless directed by a provider, and it does not fully reverse kidney damage.

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52
Q

A nurse is monitoring a patient with lupus nephritis for signs of end-stage renal disease (ESRD). Which of the following findings would be most concerning?

a. Serum creatinine of 1.2 mg/dL
b. Blood pressure of 120/80 mmHg
c. Hemoglobin level of 14 g/dL
d. Urine output of 100 mL in 12 hours

A

d. Urine output of 100 mL in 12 hours

Rationale: Oliguria (low urine output) is a key indicator of worsening renal function and possible ESRD. A creatinine level of 1.2 mg/dL and normal hemoglobin and BP levels are not immediately concerning in this context.

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53
Q

A patient with lupus nephritis is prescribed prednisone. Which of the following statements by the patient requires immediate intervention?

a. “I will take my prednisone dose in the morning with food.”

b. “I will check my blood glucose regularly since this medication can raise it.”

c. “I will stop taking my prednisone if I feel better to avoid side effects.”

d. “I will notify my provider if I develop any signs of infection.”

A

c. “I will stop taking my prednisone if I feel better to avoid side effects.”

Rationale: Abruptly stopping corticosteroids can lead to adrenal insufficiency and a lupus flare. Patients must taper the dose under medical supervision.

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54
Q

A patient with lupus nephritis asks about the long-term prognosis of their kidney disease. The nurse should base the response on which key fact?

a. “Kidney involvement in lupus is rare and not a major concern.”
b. “With proper treatment, progression to end-stage renal disease can often be slowed or prevented.”
c. “Most patients with lupus nephritis require immediate dialysis.”
d. “Your kidney function will return to normal with immunosuppressive therapy.”

A

b. “With proper treatment, progression to end-stage renal disease can often be slowed or prevented.”

Rationale: While lupus nephritis can lead to ESRD, early and aggressive treatment can slow its progression. Immediate dialysis is not required in most cases, and complete reversal of damage is not guaranteed.

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55
Q

A 32-year-old female with a 5-year history of systemic lupus erythematosus (SLE) is admitted to the hospital with confusion and visual hallucinations. The nurse notes that the patient has no prior history of psychiatric illness. Based on this presentation, which underlying mechanism is most likely responsible for her symptoms?

a. The presence of small vessel vasculopathy causing chronic ischemia

b. A focal neurological event due to antiphospholipid antibodies

c. An inflammatory process affecting the central nervous system

d. Increased stress from chronic illness leading to psychological distress

A

c. An inflammatory process affecting the central nervous system

Rationale: Diffuse neuropsychiatric SLE (NPSLE) is caused by an inflammatory process in the central nervous system and can result in acute confusion, psychosis, anxiety, depression, or cognitive impairment. While stress can contribute to symptoms, this presentation suggests an organic cause rather than psychological distress alone. Focal NPSLE, often associated with antiphospholipid antibodies, typically leads to strokes or focal deficits rather than widespread cognitive symptoms.

56
Q

A nurse is assessing a patient with SLE who reports new-onset severe headaches and difficulty speaking. The nurse should immediately assess for which complication?

a. Aseptic meningitis
b. Cerebrovascular accident (CVA)
c. Diffuse small vessel vasculopathy
d. Acute psychosis

A

b. Cerebrovascular accident (CVA)

Rationale: Patients with SLE, particularly those with antiphospholipid antibodies, are at increased risk for cerebrovascular events due to clot formation. New-onset severe headache and speech difficulties may indicate an ischemic stroke, requiring immediate assessment and intervention. While aseptic meningitis can occur, it is more likely to present with fever and neck stiffness rather than focal deficits.

57
Q

A patient with lupus presents to the clinic with symptoms of anxiety, depression, and cognitive difficulties. The provider suspects diffuse neuropsychiatric SLE (NPSLE). Which laboratory finding would support this diagnosis?

a. Positive antiphospholipid antibodies
b. Decreased erythrocyte sedimentation rate (ESR)
c. Elevated creatinine and blood urea nitrogen (BUN)
d. Hyperkalemia and metabolic acidosis

A

a. Positive antiphospholipid antibodies

Rationale: Antiphospholipid antibodies are often associated with focal NPSLE but can also contribute to diffuse neurological symptoms. Diffuse NPSLE is an inflammatory process that can cause cognitive dysfunction, anxiety, and depression. ESR is typically elevated in active SLE, and kidney function tests (creatinine/BUN) are relevant for lupus nephritis rather than neurological involvement.

58
Q

A 29-year-old female with SLE reports a worsening headache over the past week. The nurse notes no signs of infection or meningeal irritation. What is the most likely cause of this symptom?

a. Medication side effects from corticosteroid therapy
b. Bacterial meningitis secondary to immunosuppression
c. Intracranial hemorrhage due to lupus-associated vasculopathy
d. A disease flare causing an increase in headache severity

A

d. A disease flare causing an increase in headache severity

Rationale: Headaches are common in SLE and often become severe during disease flares. The absence of infection-related symptoms makes bacterial meningitis unlikely. While corticosteroids can cause headaches, they are less likely to explain a worsening headache over a week. Intracranial hemorrhage is possible but less common than inflammatory headache exacerbation.

59
Q

A patient with SLE is diagnosed with aseptic meningitis. Which clinical findings would the nurse expect?

a. Fever, neck stiffness, and photophobia
b. Progressive muscle weakness and ptosis
c. Unilateral facial drooping and hemiparesis
d. Memory loss and difficulty concentrating

A

a. Fever, neck stiffness, and photophobia

Rationale: Aseptic meningitis in SLE presents similarly to bacterial meningitis, with fever, neck stiffness, photophobia, and headache, but without an identifiable infectious organism. Muscle weakness and ptosis suggest myasthenia gravis, while hemiparesis and facial drooping are more indicative of stroke.

60
Q

A patient with lupus and positive antiphospholipid antibodies is at risk for focal neuropsychiatric SLE (NPSLE). The nurse should prioritize which intervention?

a. Monitoring for signs of stroke or transient ischemic attack
b. Assessing for gradual cognitive decline over several months
c. Educating the patient about strategies to reduce stress
d. Evaluating for hallucinations and paranoia

A

a. Monitoring for signs of stroke or transient ischemic attack

Rationale: Focal NPSLE is caused by thrombotic events in the presence of antiphospholipid antibodies, increasing the risk of stroke. Prompt recognition of signs like unilateral weakness, slurred speech, or vision changes is critical. While cognitive impairment and psychiatric symptoms can occur in lupus, they are more related to diffuse NPSLE rather than focal NPSLE.

61
Q

A nurse is caring for a patient with SLE who has been prescribed hydroxychloroquine. Which expected therapeutic effect of this medication is most relevant to hematologic complications?

a. Decreased risk of thrombosis
b. Increased hemoglobin levels
c. Prevention of leukopenia
d. Enhanced platelet production

A

a. Decreased risk of thrombosis

Rationale: Hydroxychloroquine has been shown to reduce the risk of clot formation in patients with SLE, particularly those with antiphospholipid antibodies. It does not directly increase hemoglobin, prevent leukopenia, or enhance platelet production, but it plays a crucial role in decreasing the risk of thrombotic events.

62
Q

A patient with systemic lupus erythematosus (SLE) presents with a platelet count of 45,000/mm³. Which assessment finding should the nurse immediately report to the provider?

a. Pale skin and fatigue
b. Bruising and petechiae
c. Joint pain and swelling
d. Mild gingival bleeding after brushing teeth

A

b. Bruising and petechiae

Rationale: A platelet count of 45,000/mm³ indicates thrombocytopenia, putting the patient at risk for spontaneous bleeding. Bruising and petechiae suggest increased capillary fragility and potential internal bleeding, requiring immediate evaluation. While anemia-related fatigue and mild gingival bleeding can occur, the risk of significant bleeding complications is more urgent.

63
Q

A nurse is reviewing laboratory results for a patient with SLE and notes a hemoglobin level of 8.5 g/dL, WBC count of 2,800/mm³, and platelet count of 150,000/mm³. Which condition is most likely responsible for these findings?

a. Disseminated intravascular coagulation (DIC)
b. Drug-induced bone marrow suppression
c. Autoimmune destruction of blood cells
d. Iron deficiency anemia from chronic inflammation

A

c. Autoimmune destruction of blood cells

Rationale: SLE causes hematologic abnormalities due to antibody formation against blood cells, leading to anemia (low hemoglobin) and leukopenia (low WBC count). Thrombocytopenia is also common but not present in this case. While immunosuppressive drugs can cause bone marrow suppression, the autoimmune nature of SLE makes it the more likely cause.

64
Q

A patient with lupus and antiphospholipid syndrome is receiving aspirin therapy. The provider notes the patient is resistant to the blood-thinning effects of aspirin. What is the nurse’s priority action?

a. Educate the patient on increasing dietary intake of vitamin K
b. Assess for symptoms of gastrointestinal bleeding
c. Encourage the patient to avoid all NSAIDs
d. Monitor for signs of deep vein thrombosis or stroke

A

d. Monitor for signs of deep vein thrombosis or stroke

Rationale: Patients with lupus and antiphospholipid syndrome are at high risk for clotting disorders, and aspirin resistance increases this risk. The nurse should prioritize monitoring for signs of thrombosis, such as unilateral leg swelling or neurological deficits. While gastrointestinal bleeding is a concern with aspirin, the immediate threat is clot formation rather than excessive bleeding.

65
Q

A patient with systemic lupus erythematosus (SLE) is receiving long-term corticosteroid therapy. Which statement by the patient requires further teaching?

a. “I should receive the annual influenza vaccine to help prevent infections.”
b. “I will wash my hands frequently and avoid people who are sick.”
c. “Since I’m on steroids, I should ask my doctor about getting the shingles vaccine.”
d. “I plan to get the measles, mumps, and rubella (MMR) vaccine at my next visit.”

A

d. “I plan to get the measles, mumps, and rubella (MMR) vaccine at my next visit.”

Rationale: Live virus vaccines, such as MMR, are contraindicated in patients receiving corticosteroids or cytotoxic drugs due to the risk of infection. The flu vaccine is safe, and infection prevention strategies (handwashing, avoiding sick contacts) are important for immunosuppressed patients. The recombinant (non-live) shingles vaccine is recommended, but the live version (Zostavax) should be avoided.

66
Q

A nurse is caring for a patient with SLE who has been on long-term immunosuppressive therapy. The patient reports fever, fatigue, and a new productive cough. Which nursing intervention is the highest priority?

a. Encourage the patient to rest and increase fluid intake
b. Obtain a sputum culture and prepare for a chest X-ray
c. Administer acetaminophen and reassess in 1 hour
d. Review the patient’s vaccination history

A

b. Obtain a sputum culture and prepare for a chest X-ray

Rationale: Pneumonia is the most common infection in patients with SLE, and immunosuppressive therapy increases the risk of serious bacterial infections. A sputum culture and chest X-ray are essential to confirm pneumonia and guide treatment. Rest and fluids may help, but diagnostic testing is the priority. Administering acetaminophen may mask symptoms without addressing the underlying infection.

67
Q

A patient with SLE is scheduled to receive the pneumococcal vaccine. Which statement by the patient indicates correct understanding?

a. “I need to avoid this vaccine since I take prednisone daily.”
b. “Since I already got the flu vaccine, I don’t need this one.”
c. “This vaccine will help lower my risk of getting pneumonia.”
d. “I should not receive any vaccines while taking immunosuppressive drugs.”

A

c. “This vaccine will help lower my risk of getting pneumonia.”

Rationale: Pneumonia is the most common infection in SLE, and vaccination is an important preventive measure. Inactivated vaccines, including the pneumococcal and flu vaccines, are safe and recommended for immunosuppressed patients. Live vaccines should be avoided, but inactivated vaccines are necessary to reduce infection risk.

68
Q

A patient with lupus is prescribed azathioprine for immunosuppression. Which patient statement requires immediate intervention?

a. “I will notify my doctor if I develop a fever or sore throat.”
b. “I should avoid crowded places and wash my hands frequently.”
c. “If I feel better, I can stop taking my medication without consulting my doctor.”
d. “I need to have regular blood tests to monitor my white blood cell count.”

A

c. “If I feel better, I can stop taking my medication without consulting my doctor.”

Rationale: Abruptly stopping immunosuppressive therapy can lead to lupus flares and worsen disease progression. Patients must understand that these medications require consistent use and should only be adjusted under medical supervision. The other statements reflect appropriate knowledge about infection prevention and medication monitoring.

69
Q

A patient with SLE is receiving long-term corticosteroid therapy. Which assessment finding requires immediate intervention?

a. Blood glucose level of 150 mg/dL
b. Moon face and increased abdominal fat
c. Mild bruising on the forearms
d. New onset of fever and purulent wound drainage

A

d. New onset of fever and purulent wound drainage

Rationale: Patients on corticosteroids are at high risk for infection due to immunosuppression. A new fever and purulent drainage suggest an active infection that requires immediate intervention. Elevated blood glucose and Cushingoid features (moon face, fat redistribution) are expected side effects but are not emergencies. Mild bruising is also common due to steroid-induced skin thinning.

70
Q

A nurse is reviewing the laboratory results of a patient suspected of having systemic lupus erythematosus (SLE). Which finding is most indicative of SLE?

a. Positive antinuclear antibody (ANA)
b. Elevated C-reactive protein (CRP)
c. Increased erythrocyte sedimentation rate (ESR)
d. Presence of anti-Smith (Sm) antibodies

A

d. Presence of anti-Smith (Sm) antibodies

Rationale: While ANA is present in 97% of SLE patients, it is not specific to SLE. Anti-Smith (Sm) antibodies are highly specific for SLE and strongly support the diagnosis. ESR and CRP are markers of inflammation but are not diagnostic for SLE.

71
Q

A patient with suspected SLE has a positive ANA test. The nurse anticipates which additional laboratory test to confirm the diagnosis?

a. Rheumatoid factor (RF)
b. Anti-double-stranded DNA antibodies
c. D-dimer
d. Hemoglobin A1c

A

b. Anti-double-stranded DNA antibodies

Rationale: Anti-dsDNA antibodies are more specific to SLE than ANA and help confirm the diagnosis. RF is associated with rheumatoid arthritis, D-dimer is used for clotting disorders, and hemoglobin A1c monitors blood glucose levels.

72
Q

A patient with lupus has an elevated erythrocyte sedimentation rate (ESR). What is the clinical significance of this finding?

a. Confirms a diagnosis of SLE
b. Indicates worsening renal function
c. Suggests active inflammation
d. Confirms antiphospholipid syndrome

A

c. Suggests active inflammation

Rationale: ESR is a nonspecific marker of inflammation and is used to monitor disease activity in SLE. It does not diagnose SLE, indicate renal function, or confirm antiphospholipid syndrome.

73
Q

A patient with lupus is being monitored for disease progression. Which laboratory test result would indicate worsening autoimmune activity?

a. Decreased anti-Smith (Sm) antibody levels
b. Increased C-reactive protein (CRP)
c. Decreased ANA levels
d. Increased platelet count

A

b. Increased C-reactive protein (CRP)

Rationale: CRP is an inflammatory marker that increases during disease flares and is used to monitor lupus activity. Anti-Smith antibodies do not fluctuate significantly, ANA remains positive but is not useful for monitoring, and platelet counts often decrease due to lupus-related thrombocytopenia.

74
Q

A patient with SLE is found to have antiphospholipid antibodies. What is the primary concern associated with this finding?

a. Increased risk of thrombosis
b. Decreased immune response
c. Increased susceptibility to infections
d. Worsening of joint pain

A

a. Increased risk of thrombosis

Rationale: Antiphospholipid antibodies are associated with clot formation, leading to an increased risk of deep vein thrombosis, stroke, or pulmonary embolism. They do not directly affect infection risk, immune response, or joint pain.

75
Q

A nurse is educating a newly diagnosed SLE patient about diagnostic testing. Which statement by the patient indicates correct understanding?

a. “A positive ANA test alone confirms I have lupus.”
b. “My doctor will monitor my ESR and CRP to track my disease activity.”
c. “If my anti-Smith antibodies become negative, my lupus is cured.”
d. “My diagnosis was based on a single abnormal lab test.”

A

b. “My doctor will monitor my ESR and CRP to track my disease activity.”

Rationale: ESR and CRP are used to monitor inflammation and disease activity in SLE. A positive ANA alone does not confirm lupus, anti-Smith antibodies do not disappear with remission, and SLE is diagnosed based on multiple criteria, not a single test.

76
Q

A patient with lupus is undergoing diagnostic testing. The nurse knows that which combination of laboratory findings is most consistent with SLE?

a. Positive ANA, elevated ESR, presence of anti-Smith antibodies
b. Negative ANA, low CRP, presence of rheumatoid factor
c. Positive RF, elevated platelet count, increased ESR
d. Increased CRP, negative anti-dsDNA, normal ESR

A

a. Positive ANA, elevated ESR, presence of anti-Smith antibodies

Rationale: A positive ANA is present in most SLE patients, ESR elevation indicates active inflammation, and anti-Smith antibodies are highly specific for SLE. Negative ANA and the presence of rheumatoid factor suggest rheumatoid arthritis, and normal inflammatory markers make active SLE unlikely.

77
Q

A patient with SLE expresses concern about the long-term outlook of the disease. Which response by the nurse is most appropriate?

a. “SLE is always fatal, but treatment can help extend your life.”
b. “With early diagnosis and proper treatment, you can live a long and healthy life.”
c. “You should avoid all medications during remission to prevent side effects.”
d. “Once you start treatment, you will no longer need regular follow-ups.”

A

b. “With early diagnosis and proper treatment, you can live a long and healthy life.”

Rationale: While SLE is a chronic disease, early intervention and treatment can significantly improve quality of life and survival. Avoiding medication can lead to disease flares, and regular follow-ups are necessary to monitor for complications.

78
Q

A nurse is working with an interprofessional team to develop a care plan for a patient with newly diagnosed SLE. Which priority intervention should the team focus on?

a. Monitoring for joint pain and fatigue only
b. Encouraging the patient to stop taking medications during remission
c. Limiting follow-up appointments to once a year unless symptoms worsen
d. Assessing for organ involvement and disease severity

A

d. Assessing for organ involvement and disease severity

Rationale: Since SLE can affect multiple organs, early detection of complications is essential to improve prognosis. Monitoring only joint pain and fatigue ignores other systemic effects. Medication adherence and routine follow-up visits are critical for disease management.

79
Q

A nurse is educating a newly diagnosed SLE patient about factors that influence disease prognosis. Which statement by the patient indicates a need for further teaching?

a. “Early diagnosis and treatment can improve my long-term outcomes.”
b. “My social and economic situation can impact how well I manage my lupus.”
c. “Since I am young, my lupus will not cause any severe complications.”
d. “Ongoing monitoring is important to recognize early organ involvement.”

A

c. “Since I am young, my lupus will not cause any severe complications.”

Rationale: SLE can cause severe complications regardless of age, including organ damage. Early diagnosis, social determinants of health, and ongoing monitoring all influence disease outcomes.

80
Q

A patient with SLE is receiving corticosteroids to manage an acute disease flare. What is the primary concern when managing active disease while preventing complications of treatment?

a. Risk of hypoglycemia
b. Increased risk of infection
c. Development of hyperkalemia
d. Increased platelet aggregation

A

b. Increased risk of infection

Rationale: Corticosteroids suppress the immune system, increasing the risk of infections. They are more commonly associated with hyperglycemia rather than hypoglycemia, hypokalemia rather than hyperkalemia, and do not directly cause increased platelet aggregation.

81
Q

The interprofessional team is developing a treatment plan for a patient with severe SLE and organ involvement. Which approach is most effective in improving the patient’s long-term prognosis?

a. Symptom management with NSAIDs alone
b. Avoidance of immunosuppressants due to side effects
c. Discontinuing medications during periods of remission
d. Early diagnosis, routine assessment, and prompt intervention

A

d. Early diagnosis, routine assessment, and prompt intervention

Rationale: A comprehensive approach that includes early detection, frequent monitoring, and immediate treatment of organ involvement improves survival. NSAIDs alone are not sufficient for severe SLE, and immunosuppressants are necessary despite side effects. Stopping medications during remission can lead to disease flares.

82
Q

A patient with SLE is prescribed long-term NSAID therapy for joint pain. Which assessment finding requires immediate intervention?

a. Mild nausea after taking the medication
b. Dark, tarry stools
c. Fatigue and muscle aches
d. Occasional headaches

A

b. Dark, tarry stools

Rationale: Dark, tarry stools indicate gastrointestinal (GI) bleeding, a serious adverse effect of NSAIDs. Long-term NSAID use increases the risk of peptic ulcers and GI bleeding, requiring close monitoring.

83
Q

A nurse is providing discharge teaching to a patient with SLE who is prescribed hydroxychloroquine. Which statement by the patient indicates an understanding of the medication?

a. “I need to have an eye exam every 6 to 12 months.”
b. “This medication causes severe immunosuppression.”
c. “If I miss a dose, I should double the next one.”
d. “I should stop this medication if I feel better.”

A

a. “I need to have an eye exam every 6 to 12 months.”

Rationale: Hydroxychloroquine can cause retinopathy over time, requiring regular ophthalmologic exams. It does not cause significant immunosuppression, doses should not be doubled, and stopping it abruptly can lead to disease flares.

84
Q

A patient with SLE is prescribed corticosteroids for a severe flare. Which instruction is most important for the nurse to provide?

a. “Take the medication only when symptoms worsen.”
b. “Stop the medication immediately if side effects occur.”
c. “Taper the dose gradually rather than stopping abruptly.”
d. “Expect to take this medication at high doses for life.”

A

c. “Taper the dose gradually rather than stopping abruptly.”

Rationale: Corticosteroids must be tapered slowly to prevent adrenal insufficiency. Stopping them suddenly can cause life-threatening complications.

85
Q

A patient with severe cutaneous SLE is prescribed high-dose corticosteroids. What is the primary concern with this treatment?

a. Increased risk of infection
b. Severe bradycardia
c. Hypercoagulability
d. Increased tear production

A

a. Increased risk of infection

Rationale: Corticosteroids suppress the immune system, increasing the risk of infections. Patients should be monitored for signs of infection, and live vaccines should be avoided.

86
Q

A patient with SLE who has a history of blood clots is prescribed warfarin. What laboratory value should the nurse monitor?

a. Platelet count
b. White blood cell count
c. International normalized ratio (INR)
d. Serum creatinine

A

c. International normalized ratio (INR)

Rationale: INR is monitored in patients on warfarin to assess clotting risk. A therapeutic INR reduces the likelihood of clot formation in SLE patients prone to hypercoagulability.

87
Q

A patient with SLE who cannot tolerate hydroxychloroquine is prescribed dapsone. What adverse effect should the nurse monitor for?

a. Peripheral neuropathy
b. Hyperglycemia
c. Bradycardia
d. Osteoporosis

A

a. Peripheral neuropathy

Rationale: Dapsone, an antileprosy drug, is used when hydroxychloroquine is not tolerated. A known side effect is peripheral neuropathy, requiring close monitoring.

88
Q

Which medication is most appropriate for a patient with SLE experiencing severe skin lesions resistant to corticosteroids?

a. Azathioprine
b. Tacrolimus
c. Hydroxychloroquine
d. Warfarin

A

b. Tacrolimus

Rationale: Tacrolimus is a topical immunomodulator that suppresses immune activity in the skin and is used for treating severe skin lesions when corticosteroids are ineffective.

89
Q

A nurse is monitoring a patient receiving cyclophosphamide for SLE. What is the most important assessment?

a. Blood pressure readings
b. Skin turgor
c. Reflex assessments
d. Complete blood count (CBC)

A

d. Complete blood count (CBC)

Rationale: Cyclophosphamide is an immunosuppressive drug that can cause bone marrow suppression, leading to leukopenia, anemia, and thrombocytopenia. Monitoring CBC is essential to detect complications early.

90
Q

A patient with SLE asks why serial anti-DNA titers and serum complement levels are being monitored. What is the nurse’s best response?

a. “These tests assess your kidney function.”
b. “They determine whether you are at risk for infections.”
c. “They evaluate your cardiovascular health.”
d. “They help us monitor your disease activity and treatment effectiveness.”

A

d. “They help us monitor your disease activity and treatment effectiveness.”

Rationale: Serial anti-DNA titers and serum complement levels indicate disease activity. Elevated anti-DNA titers suggest worsening disease, while low complement levels indicate immune complex formation.

91
Q

A patient with SLE is receiving long-term azathioprine therapy. What is the most important teaching point?

a. “Avoid prolonged sun exposure.”
b. “Increase your daily protein intake.”
c. “Report any signs of infection immediately.”
d. “Take the medication on an empty stomach.”

A

c. “Report any signs of infection immediately.”

Rationale: Azathioprine is an immunosuppressant that increases the risk of infections. Patients must be educated on recognizing and reporting early signs of infection.

92
Q

A patient with mild SLE joint pain is prescribed NSAIDs. Which patient history finding requires the nurse to consult with the provider before administering the medication?

a. History of gastritis
b. Hypertension
c. Seasonal allergies
d. History of migraines

A

a. History of gastritis

Rationale: NSAIDs can cause GI irritation and worsen conditions like gastritis, increasing the risk of ulcers and bleeding. Alternative pain management strategies should be considered.

93
Q

A nurse is reviewing the medication list of a patient with SLE. Which medication should the nurse question?

a. Hydroxychloroquine
b. Prednisone
c. Live-attenuated influenza vaccine
d. Tacrolimus

A

c. Live-attenuated influenza vaccine

Rationale: Patients receiving corticosteroids or immunosuppressants should avoid live vaccines due to the risk of infection.

94
Q

A patient with SLE has been prescribed pimecrolimus for a facial rash. What is an important nursing instruction?

a. “Apply a thick layer of the medication to the affected area.”
b. “Use sunscreen when outdoors.”
c. “Discontinue immediately if mild redness occurs.”
d. “Take the medication with food to reduce GI upset.”

A

b. “Use sunscreen when outdoors.”

Rationale: Pimecrolimus is a topical immunomodulator that increases photosensitivity, requiring sun protection.

95
Q

A patient with severe lupus nephritis is prescribed mycophenolate mofetil. What is the primary goal of this medication?

a. Improve energy levels
b. Reduce headaches
c. Increase platelet count
d. Preserve renal function

A

d. Preserve renal function

Rationale: Mycophenolate mofetil is an immunosuppressant used to prevent renal damage in lupus nephritis, helping to slow disease progression and maintain kidney function.

96
Q

A nurse is assessing a patient with SLE who reports increased fatigue and joint pain. Which additional finding would indicate a possible disease flare?

a. Decreased ESR and CRP levels
b. Weight loss and increased urine output
c. New-onset fever and worsening joint inflammation
d. Decreased creatinine clearance and increased hemoglobin

A

c. New-onset fever and worsening joint inflammation

Rationale: Disease flares in SLE often present with fever, increased joint inflammation, and worsening fatigue. ESR and CRP levels would typically be elevated, and kidney involvement may lead to fluid retention rather than increased urine output.

97
Q

A patient with SLE is receiving corticosteroid therapy. Which assessment finding requires immediate intervention?

a. Mild bruising on the arms
b. 2+ pitting edema in the ankles
c. Dark, tarry stools
d. Increased hunger and thirst

A

c. Dark, tarry stools

Rationale: Tarry stools indicate GI bleeding, a serious adverse effect of corticosteroids. While mild bruising, edema, and increased appetite are expected side effects, GI bleeding requires immediate medical attention.

98
Q

A nurse is monitoring the intake and output of a patient with SLE who is taking corticosteroids. Which finding requires further evaluation?

a. Weight gain of 5 lbs in 1 week
b. Urine output of 1,500 mL in 24 hours
c. Reports of mild nausea after eating
d. Serum creatinine of 0.9 mg/dL

A

a. Weight gain of 5 lbs in 1 week

Rationale: Rapid weight gain suggests fluid retention, a common side effect of corticosteroids that can lead to complications such as hypertension and renal impairment.

99
Q

A patient with SLE reports tingling and numbness in the hands and feet. What is the nurse’s priority assessment?

a. Check for signs of Raynaud’s phenomenon
b. Assess for peripheral neuropathy
c. Monitor for worsening joint inflammation
d. Evaluate blood glucose levels

A

b. Assess for peripheral neuropathy

Rationale: Peripheral neuropathy, a complication of SLE, can cause numbness, tingling, and weakness in the extremities. It must be assessed to prevent worsening nerve damage.

100
Q

A nurse is evaluating the neurologic status of a patient with SLE. Which assessment finding is most concerning?

a. Mild headache that resolves with rest
b. Occasional forgetfulness
c. Sensitivity to bright light
d. Personality changes and confusion

A

d. Personality changes and confusion

Rationale: Personality changes and confusion may indicate CNS involvement of SLE or corticosteroid-induced psychosis, both of which require urgent intervention.

101
Q

A patient with SLE is prescribed a 24-hour urine collection for protein and creatinine clearance. Which patient statement indicates a need for further teaching?

a. “I will discard the first urine sample when I start the collection.”
b. “I will store the urine container in a cool place.”
c. “I will collect my urine for a full 12 hours instead of 24 hours.”
d. “I will avoid contaminating the urine with stool.”

A

c. “I will collect my urine for a full 12 hours instead of 24 hours.”

Rationale: A full 24-hour urine collection is necessary to accurately measure proteinuria and creatinine clearance. Incomplete collection may lead to inaccurate results.

102
Q

A patient with SLE presents with pallor, bruising, and petechiae. What is the nurse’s priority action?

a. Check the patient’s platelet count
b. Assess for joint pain and swelling
c. Monitor urine output
d. Evaluate for peripheral neuropathy

A

a. Check the patient’s platelet count

Rationale: Pallor, bruising, and petechiae may indicate thrombocytopenia, a complication of SLE or its treatment. A platelet count should be obtained to assess bleeding risk.

103
Q

A nurse is assessing a patient with SLE who is receiving corticosteroids. Which neurologic finding suggests an adverse effect of the medication?

a. Insomnia and restlessness
b. Mild forgetfulness
c. Sudden onset of hallucinations and paranoia
d. Sensitivity to noise

A

c. Sudden onset of hallucinations and paranoia

Rationale: Corticosteroid-induced psychosis can cause hallucinations, paranoia, and severe mood changes, requiring urgent intervention.

104
Q

A nurse is caring for a patient with SLE experiencing severe fatigue. What intervention is most appropriate?

a. Encourage the patient to avoid naps during the day
b. Promote energy conservation techniques
c. Discourage physical activity to prevent exhaustion
d. Administer high-dose corticosteroids for immediate relief

A

b. Promote energy conservation techniques

Rationale: Energy conservation techniques, such as balancing rest and activity, can help patients manage fatigue without overexertion.

105
Q

A patient with SLE is experiencing a flare and has a fever of 101°F (38.3°C). What is the nurse’s priority assessment?

a. Monitor for signs of infection
b. Encourage increased physical activity
c. Administer antipyretic medication
d. Evaluate the patient’s recent food intake

A

a. Monitor for signs of infection

Rationale: Patients with SLE are at increased risk for infections due to immunosuppressive therapy. Fever may indicate infection rather than a disease flare, requiring further assessment.

106
Q

A patient with SLE reports difficulty performing daily activities due to joint pain and stiffness. What is the most appropriate nursing intervention?

a. Encourage the patient to engage in high-impact exercise to maintain joint mobility

b. Recommend frequent periods of rest and assistive devices as needed

c. Advise the patient to completely avoid physical activity to prevent further joint damage

d. Suggest applying ice packs to joints before engaging in activity

A

b. Recommend frequent periods of rest and assistive devices as needed

Rationale: Patients with SLE often experience musculoskeletal problems, including joint pain and stiffness. Balancing rest with activity and using assistive devices can help improve mobility while preventing excessive fatigue and joint stress.

107
Q

A nurse is caring for a patient with SLE who has a butterfly rash and reports increased skin sensitivity. What is the priority teaching for this patient?

a. Apply topical corticosteroids daily and avoid moisturizer

b. Use sunscreen and wear protective clothing when outdoors

c. Wash the affected area frequently with antibacterial soap

d. Limit fluid intake to reduce swelling and skin irritation

A

b. Use sunscreen and wear protective clothing when outdoors

Rationale: Impaired tissue integrity in SLE, including the characteristic butterfly rash, can worsen with sun exposure. Patients should be advised to use sunscreen and wear protective clothing to prevent flare-ups and skin damage.

108
Q

A nurse is developing a care plan for a patient with SLE. Which intervention best supports the goal of maintaining optimal role function?

a. Encourage the patient to rest frequently and avoid social activities to reduce fatigue

b. Teach the patient energy conservation techniques and allow flexibility in daily routines

c. Instruct the patient to avoid all physical activity to prevent disease exacerbation

d. Recommend the patient take high-dose corticosteroids daily to prevent flares

A

b. Teach the patient energy conservation techniques and allow flexibility in daily routines

Rationale: Patients with SLE often experience fatigue and pain that can interfere with daily activities. Teaching energy conservation techniques, such as pacing activities and prioritizing tasks, helps the patient maintain independence and role function while minimizing fatigue.

109
Q

A patient with SLE expresses frustration about the changes in their appearance due to the disease. What is the most appropriate nursing intervention to promote a positive self-image?

a. Encourage the patient to focus on other aspects of life and ignore their appearance

b. Suggest wearing long-sleeved clothing and makeup to cover skin changes

c. Provide emotional support and discuss coping strategies for body image changes

d. Advise the patient to avoid mirrors to reduce distress over their appearance

A

c. Provide emotional support and discuss coping strategies for body image changes

Rationale: SLE can cause visible changes, such as skin rashes and weight fluctuations from corticosteroid use, which may impact self-esteem. Providing emotional support and discussing coping strategies, such as makeup techniques and counseling, can help the patient maintain a positive self-image.

110
Q

A nurse is providing discharge teaching to a patient with SLE. Which statement by the patient indicates a need for further education?

a. “I will make sure to take my medications as prescribed, even if I start feeling better.”
b. “I should avoid excessive sun exposure and wear sunscreen to prevent disease flares.”
c. “If I start feeling stressed, I don’t need to worry about it affecting my condition.”
d. “I will notify my provider if I develop any signs of infection while on immunosuppressive therapy.”

A

c. “If I start feeling stressed, I don’t need to worry about it affecting my condition.”

Rationale: Emotional stress is a known trigger for SLE flares. Patients should be educated on stress management techniques to help reduce disease exacerbations.

111
Q

A patient with SLE is prescribed hydroxychloroquine. What should the nurse include in the patient’s medication education?

a. “You will need regular eye exams every 6 to 12 months while taking this medication.”
b. “This medication will cure your lupus and prevent further disease flares.”
c. “If you experience nausea, stop taking the medication immediately.”
d. “Hydroxychloroquine is a fast-acting medication that provides immediate symptom relief.”

A

a. “You will need regular eye exams every 6 to 12 months while taking this medication.”

Rationale: Hydroxychloroquine can cause retinal toxicity with long-term use. Regular ophthalmologic evaluations are essential for early detection and prevention of vision loss.

112
Q

A nurse is teaching a patient with SLE about ways to prevent disease exacerbations. Which statement by the patient indicates understanding of the teaching?

a. “I will increase my outdoor activities to improve my overall health.”
b. “I can stop taking my medications when I start feeling better to avoid side effects.”
c. “I don’t need to worry about monitoring for infections since I’m on anti-inflammatory drugs.”
d. “I should avoid live virus vaccines while taking immunosuppressive drugs.”

A

d. “I should avoid live virus vaccines while taking immunosuppressive drugs.”

Rationale: Patients with SLE who are on immunosuppressive therapy should avoid live vaccines due to the risk of infection. They should receive inactivated vaccines instead.

113
Q

A nurse is educating the caregiver of a patient with SLE about managing the disease at home. Which instruction is most important for the caregiver to understand?

a. “Encourage the patient to get at least 12 hours of sleep per day to prevent flares.”
b. “Encourage the patient to gradually stop taking corticosteroids when symptoms improve.”
c. “Monitor the patient for signs of infection, such as fever or unusual fatigue, and report them to the provider.”
d. “Limit the patient’s intake of fluids to prevent fluid retention.”

A

c. “Monitor the patient for signs of infection, such as fever or unusual fatigue, and report them to the provider.”

Rationale: Patients with SLE are at increased risk for infection due to both the disease and immunosuppressive treatment. Early detection of infection is critical to prevent complications.

114
Q

A patient with SLE asks the nurse how to reduce the risk of disease exacerbation. Which factor should the nurse advise the patient to avoid?

a. Drinking at least 8 glasses of water per day
b. Taking prescribed medications consistently
c. Excessive sun exposure and emotional stress
d. Maintaining a healthy diet and regular exercise

A

c. Excessive sun exposure and emotional stress

Rationale: Sun exposure and emotional stress are known triggers for lupus flares. Patients should be educated to avoid prolonged sun exposure and practice stress management techniques.

115
Q

A nurse is reinforcing medication education for a patient newly diagnosed with SLE. Which statement by the patient indicates the need for further teaching?

a. “I should take my medications exactly as prescribed, even if I feel better.”
b. “I will have regular blood tests to monitor for medication side effects.”
c. “I need to report any unusual bleeding or bruising to my provider.”
d. “I can stop taking my corticosteroids suddenly if I don’t like the side effects.”

A

d. “I can stop taking my corticosteroids suddenly if I don’t like the side effects.”

Rationale: Corticosteroids should never be stopped abruptly, as this can lead to adrenal insufficiency and worsening of disease symptoms. They should be tapered gradually under medical supervision.

116
Q

A nurse is providing discharge education to a young adult patient with SLE who is concerned about the impact of the disease on her career. Which statement by the patient indicates understanding of the teaching?

a. “I will plan my work activities to include periods of rest to help manage fatigue.”
b. “I should avoid telling my employer about my diagnosis to prevent discrimination.”
c. “I should change my career plans because SLE will prevent me from working long-term.”
d. “I will only need to adjust my work routine during disease flares.”

A

a. “I will plan my work activities to include periods of rest to help manage fatigue.”

Rationale: Fatigue is a common symptom of SLE. Planning rest periods can help the patient maintain productivity and energy levels without worsening symptoms.

117
Q

A patient with SLE expresses concerns about how the disease will affect her ability to start a family. Which response by the nurse is most appropriate?

a. “SLE does not affect pregnancy, so you do not need to worry.”
b. “Many patients with SLE can have successful pregnancies with proper medical management.”
c. “You should consider avoiding pregnancy, as SLE always leads to complications.”
d. “You should focus on your health and reconsider having children in the future.”

A

b. “Many patients with SLE can have successful pregnancies with proper medical management.”

Rationale: While pregnancy can be high-risk for patients with SLE, many women successfully have children with careful monitoring and medical management.

118
Q

A patient with SLE is struggling with self-esteem due to physical changes from the disease. Which nursing intervention is most appropriate?

a. Encourage the patient to focus on medical treatment rather than appearance.

b. Suggest that the patient avoid social interactions to reduce emotional stress.

c. Help the patient explore ways to enhance self-image, such as makeup or wigs for hair loss.

d. Remind the patient that appearance is not important compared to overall health.

A

c. Help the patient explore ways to enhance self-image, such as makeup or wigs for hair loss.

Rationale: SLE can cause visible physical changes, such as skin rashes and hair loss. Encouraging adaptive strategies can help improve self-esteem and emotional well-being.

119
Q

A young adult patient with SLE is struggling with fatigue and is concerned about maintaining a social life. What is the best advice the nurse can provide?

a. “You should avoid socializing to conserve your energy for essential tasks.”

b. “Social activities will always be difficult with SLE, so you may need to adjust your expectations.”

c. “Fatigue is a normal part of SLE, and there is not much you can do about it.”

d. “Pace yourself and plan social activities when you feel well-rested to prevent exhaustion.”

A

d. “Pace yourself and plan social activities when you feel well-rested to prevent exhaustion.”

Rationale: Fatigue management strategies, such as activity pacing, allow patients with SLE to maintain a fulfilling social life while avoiding excessive exhaustion.

120
Q

A patient with SLE is concerned about how to explain her disease to her coworkers. Which recommendation by the nurse is most appropriate?

a. “You don’t need to tell your coworkers about your condition if it makes you uncomfortable.”

b. “Be honest about your condition and explain that you may need accommodations during flares.”

c. “Avoid discussing your disease at work to prevent unnecessary attention or judgment.”

d. “Tell your employer only if you experience symptoms that interfere with work.”

A

b. “Be honest about your condition and explain that you may need accommodations during flares.”

Rationale: Open communication with coworkers and employers can help ensure understanding and accommodations, improving the patient’s ability to maintain a stable work-life balance.

121
Q

A patient with SLE is planning to conceive. Which statement by the nurse is most appropriate?

a. “Pregnancy should be planned when disease activity is minimal for the best outcome.”

b. “You should conceive as soon as possible before your disease progresses.”

c. “SLE does not affect pregnancy, so you can conceive at any time.”

d. “It is recommended that women with SLE avoid pregnancy due to high risks.”

A

a. “Pregnancy should be planned when disease activity is minimal for the best outcome.”

Rationale: Pregnancy during active SLE increases the risk of complications. Planning pregnancy during a period of minimal disease activity improves outcomes.

122
Q

A pregnant patient with SLE asks if she can continue taking hydroxychloroquine. What is the best response by the nurse?

a. “You should discontinue hydroxychloroquine immediately, as it is harmful to the baby.”
b. “Hydroxychloroquine is safe during pregnancy and may help control disease activity.”
c. “You should switch to methotrexate, as it is safer during pregnancy.”
d. “All medications for SLE should be stopped during pregnancy.”

A

b. “Hydroxychloroquine is safe during pregnancy and may help control disease activity.”

Rationale: Hydroxychloroquine is considered safe in pregnancy and can help reduce SLE flares.

123
Q
  1. Which pregnancy complication is most common in patients with SLE?
    a. Gestational diabetes
    b. Neural tube defects
    c. Intrauterine growth restriction (IUGR)
    d. Placenta previa
A

c. Intrauterine growth restriction (IUGR)

Rationale: Immune complex deposition and inflammation in placental blood vessels can lead to IUGR, stillbirth, and spontaneous abortion.

124
Q

A woman with SLE is inquiring about pregnancy risks. Which statement by the nurse is correct?

a. “If you have severe organ involvement, pregnancy may not be recommended.”
b. “Pregnancy has no effect on SLE, so your risks are the same as other women.”
c. “You are at low risk for complications as long as you take corticosteroids.”
d. “If you have SLE, your child will definitely develop the disease.”

A

a. “If you have severe organ involvement, pregnancy may not be recommended.”

Rationale: Women with severe renal, lung, CNS, or cardiovascular involvement may be advised against pregnancy due to high maternal and fetal risks.

125
Q

A pregnant patient with SLE is experiencing a disease flare. What is the priority nursing intervention?

a. Increase corticosteroid dosage to high levels immediately.
b. Assess for signs of preeclampsia and fetal distress.
c. Stop all immunosuppressive medications immediately.
d. Advise the patient to prepare for an emergency cesarean delivery.

A

b. Assess for signs of preeclampsia and fetal distress.

Rationale: SLE flares during pregnancy can mimic preeclampsia, so careful assessment of maternal and fetal well-being is essential.

126
Q

Which statement by a patient with SLE who is postpartum indicates a need for further teaching?

a. “I should monitor for signs of an SLE flare after delivery.”
b. “I understand that my disease activity may increase after giving birth.”
c. “I can stop taking my medications now that my pregnancy is over.”
d. “I should continue working closely with my doctor during the postpartum period.”

A

c. “I can stop taking my medications now that my pregnancy is over.”

Rationale: The postpartum period is a high-risk time for SLE flares, so patients should continue prescribed treatment.

127
Q

Which medication should be discontinued at least 3 months before attempting pregnancy in a patient with SLE?

a. Hydroxychloroquine
b. Methotrexate
c. Low-dose aspirin
d. Acetaminophen

A

b. Methotrexate

Rationale: Methotrexate is teratogenic and should be stopped at least 3 months before conception.

128
Q

A pregnant patient with SLE asks whether therapeutic abortion reduces the risk of SLE flares. What is the best response by the nurse?

a. “Yes, terminating the pregnancy will prevent postpartum disease flares.”
b. “Abortion is the only way to prevent pregnancy complications with SLE.”
c. “You should not worry about SLE flares during pregnancy or postpartum.”
d. “No, therapeutic abortion has the same risk of postdelivery exacerbation as carrying to term.”

A

d. “No, therapeutic abortion has the same risk of postdelivery exacerbation as carrying to term.”

Rationale: Both pregnancy and abortion can trigger postpartum SLE flares, so patients should be monitored closely in either case.

129
Q

Which statement by a patient with SLE indicates that the expected outcomes of treatment have been met?

a. “I try to push through my fatigue and complete all my daily tasks.”

b. “I apply sunscreen and wear protective clothing whenever I go outside.”

c. “I stopped using my topical treatments because my rash has improved.”

d. “I don’t think my lifestyle needs to change because my energy levels are unpredictable.”

A

b. “I apply sunscreen and wear protective clothing whenever I go outside.”

Rationale: Using sunscreen and protective clothing demonstrates an understanding of disease prevention and adherence to treatment recommendations.

130
Q

A nurse is evaluating a patient’s understanding of energy conservation with SLE. Which statement indicates a need for further teaching?

a. “I plan my activities so I can rest between tasks.”

b. “I listen to my body and take breaks when I feel fatigued.”

c. “I try to complete all my household chores in the morning before I get too tired.”

d. “I prioritize important activities and delegate when possible.”

A

c. “I try to complete all my household chores in the morning before I get too tired.”

Rationale: This approach may lead to overexertion and worsen fatigue. Patients should pace themselves and include regular rest periods.

131
Q

In teaching a patient with systemic lupus erythematosus about the disorder, the nurse knows the pathophysiology 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.

A

d. the production of a variety of autoantibodies directed against components of the cell nucleus.

132
Q

Which statement by a patient with systemic lupus erythematosus (SLE) indicates the patient understands the nurse‘s teaching about the condition?

a. “I will exercise even if I am tired.”

b. “I will use sunscreen when I am outside.”

c. “I should avoid nonsteroidal antiinflammatory drugs.”

d. “I should take birth control pills to avoid getting pregnant.”

A

b. “I will use sunscreen when I am outside.”

Rationale: Severe skin reactions can occur in patients with SLE who are exposed to the sun. Patients would avoid fatigue by balancing exercise with rest periods as needed. Oral contraceptives can exacerbate lupus. Aspirin and nonsteroidal antiinflammatory drugs are used to treat the musculoskeletal manifestations of SLE.

133
Q

A 25-yr-old female patient with systemic lupus erythematosus (SLE) has a facial rash and alopecia. She tells the nurse, “I never leave my house because I hate the way I look.” Which patient problem would the nurse plan to address?

a. Activity intolerance

b. Impaired socialization

c. Impaired tissue integrity

d. Impaired communication

A

b. Impaired socialization

Rationale: The patient‘s statement about not going anywhere because of hating the way he or she looks expresses impaired socialization, an insufficient quantity of human Interaction, 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. The rash with SLE does not impair tissue integrity. There is no evidence of impaired communication ability for this patient.

134
Q

A new clinic patient with joint swelling and pain is having diagnostic tests. Which test would the nurse identify as specific to systemic lupus erythematosus?

a. Rheumatoid factor (RF)

b. Antinuclear antibody (ANA)

c. Anti-Smith antibody (Anti-Sm)

d. Lupus erythematosus (LE) cell prep

A

c. Anti-Smith antibody (Anti-Sm)

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.

135
Q

The health care provider has prescribed the following interventions for a patient who is taking azathioprine (Imuran) for systemic lupus erythematosus. Which order would the nurse question?

a. Draw anti-DNA blood titer.

b. Administer varicella vaccine.

c. Naproxen 200 mg twice daily.

d. Famotidine (Pepcid) 20 mg daily.

A

b. Administer varicella vaccine.

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

136
Q

Which result for a patient with systemic lupus erythematosus (SLE) would the nurse identify as most important to communicate to the health care provider?

a. Decreased C-reactive protein (CRP)

b. Elevated blood urea nitrogen (BUN)

c. Positive antinuclear antibodies (ANA)

d. Positive lupus erythematosus cell prep

A

b. Elevated blood urea nitrogen (BUN)

Rationale: Elevated BUN and serum creatinine indicate possible lupus nephritis and a need for a change in therapy to avoid further renal damage. The positive lupus erythematosus cell prep and ANA would be expected in a patient with SLE. A drop in CRP shows decreased inflammation.

MS3 (30 decks)

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