CH 64 Systemic Lupus Erythematosus

Which hematologic disorders are frequently associated with systemic lupus erythematosus (SLE)? Select all that apply. a. Leukopenia b. Leukocytosis c. Erythrocytosis d. Hemolytic anemia e. Thrombocytopenia

ANS: A D E

Which body systems can be affected in patients with systemic lupus erythematosus (SLE) who become pregnant? Select all that apply. a. Renal b. Pulmonary c. Integumentary d. Cardiovascular e. Central nervous system (CNS)

ANS: A B D E The cardiovascular, pulmonary, renal, and central nervous systems may all be affected in pregnant patients with SLE. The integumentary system is more likely affected by sun exposure than pregnancy.

A patient with systemic lupus erythematosus (SLE) arrives at the emergency department with a two-day history of intermittent fever, fatigue, and pain. Which subjective symptoms does the nurse know must be assessed immediately? Select all that apply. a. Pain ratings b. Blood sugar c. Urine output d. Fever patterns e. Joint inflammation

ANS: A D E Patients with flares of SLE often have joint inflammation, fever, and pain that can progress to severe illness. Urine output and blood sugars are objective symptoms that will be more fully addressed during a later assessment.

What integumentary change does the nurse expect to find in a patient with suspected systemic lupus erythematosus (SLE)? a. Alopecia b. Dysphagia c. Splenomegaly d. Cognitive impairment

ANS: A Alopecia is an integumentary manifestation of SLE. Dysphagia is a gastrointestinal disorder found in SLE patients. Splenomegaly is a hematologic disorder of SLE patients. Cognitive impairment is due to neurologic disturbances.

What feature is characteristic of systemic lupus erythematosus (SLE)? a. Butterfly rash b. Erythema migrans c. Deformity of the foot d. Advanced ankylosing spondylitis

ANS: A Butterfly rash over the cheeks and the bridge of the nose is a characteristic feature of SLE. Erythema migrans is a characteristic skin lesion of Lyme disease; it occurs at the site of a tick bite. Advanced ankylosing spondylitis is not characteristic of SLE. Kyphotic posture is seen in advanced cases. Deformities of the foot are often associated with rheumatoid arthritis.

Survival in patients with systemic lupus erythematosus (SLE) is dependent on which factors? Select all that apply. a. Age b. Sex c. Race d. Comorbid conditions e. Nonsteroidal antiinflammatory drug (NSAID) use

ANS: A B C D A major challenge in SLE treatment is managing active disease while preventing complications. Survival appears to be influenced by several factors, including comorbid conditions, race, age, sex, and socioeconomic status. NSAID use is a mainstay of drug therapy in the treatment of arthritis associated with SLE, not an influencing factor for survival.

A patient is suspected of having systemic lupus erythematosus (SLE). Which would be considered diagnostic for systemic lupus erythematosus? a. Anti-Smith antibody b. Lupus erythematosus c. Swan-neck deformity d. Raynaud's phenomenon

ANS: A Anti-Smith antibodies, swan-neck deformity, antinuclear antibodies, and Raynaud's phenomenon are all found in patients with systemic lupus erythematosus (SLE). Anti-Smith antibodies are present in 30 to 40 percent of patients with lupus and are almost always considered diagnostic of SLE. The lupus erythematosus cell prep test is nonspecific to SLE. Hence, it is not diagnostic of SLE. Swan-neck deformity is not specific to SLE. It is also found in patients with rheumatoid arthritis. Raynaud's phenomenon is also found in other diseases, such as scleroderma.

A patient with systemic lupus erythematosus (SLE) arrives at the clinic with a one-month history of a cough. The patient also says, "Sometimes I feel like my heart is racing." What does the nurse suspect the patient may have? a. Lung disease b. Heart disease c. Kidney disease d. Musculoskeletal disease

ANS: A Cough and tachypnea in patients with SLE suggest the presence of lung disease. Arthralgia is the most common musculoskeletal dysfunction associated with SLE and is marked by stiffness and pain. Pericarditis is a common cardiac disease associated with SLE but does not include a cough. Kidney disease would likely present initially with mild proteinuria or progress to a variety of dysfunctions.

A patient being treated with medication for systemic lupus erythematosus (SLE) has developed psychosis. Which medication should the nurse suspect may be causing this symptom? a. Corticosteroids b. Antimalarial agents c. Immunosuppressants d. Nonsteroidal antiinflammatory agents

ANS: A If a person with SLE develops psychosis, it may be due to the disease itself or may be due to side effects of corticosteroids. Hence corticosteroids may need to be discontinued. Some patients with SLE may not tolerate antimalarial drugs, but these drugs do not cause psychosis. Long term use of corticosteroids is reduced with immunosuppressants. Nonsteroidal antiinflammatory drugs are used for polyarthritis or polyarthralgias. These drugs may cause gastrointestinal and renal effects, not psychosis.

The nurse is performing an assessment for a patient with suspected systemic lupus erythematosus (SLE). Which finding would the nurse determine is due to Raynaud's phenomenon? a. Cyanosis of fingers b. Swan neck deformity of the fingers c. Persistent lesions and photosensitivity d. Rashes over the cheeks and bridge of the nose

ANS: A In patients with SLE, there is symmetric pallor and cyanosis of fingers. This occurs due to Raynaud's phenomenon. Swan neck deformity of the fingers is a lupus-related arthritis or a musculoskeletal problem of SLE. Persistent lesions and photosensitivity along with mild systemic disease occur in subacute cutaneous lupus syndrome. Rash over the cheeks and bridge of the nose is a classic feature of SLE. It is called butterfly rash.

A patient is experiencing a side effect of antimalarial agent therapy for the treatment of systemic lupus erythematosus (SLE) patients. Which disorder does the nurse educate the patient is reversible when treatment is discontinued? a. Retinopathy b. Nephropathy c. Lymphadenopathy d. Peripheral neuropathy

ANS: A Retinopathy can develop due to high doses of antimalarial drugs but the condition usually reverses when these drugs are discontinued. Nephropathy is a renal complication that occurs in SLE and is not a side effect of antimalarial drugs. Lymphadenopathy is a hematologic disorder associated with SLE and is not a side effect of antimalarial drugs. Peripheral neuropathy is a neurologic condition associated with SLE for which antimalarial drugs are not given.

A patient newly diagnosed with systemic lupus erythematosus (SLE) is setting care goals with the nurse. What are the most appropriate goals for this patient? Select all that apply. a. Adhere to the therapeutic regimen. b. Have satisfactory pain management. c. Maintain optimal role function and positive self-image. d. Prevent all infections by utilizing proper hand hygiene. e. Demonstrate awareness of an avoid activities that worsen the disease.

ANS: A B C E Overall goals for the patient with SLE are that the patient will adhere to the therapeutic regimen to achieve maximum symptom management; have satisfactory pain management; maintain optimal role function and positive self-image; and demonstrate awareness of and avoid activities that worsen the disease. Proper hand hygiene is important, but it may not be possible to prevent all infections with this tactic alone or at all.

The nurse is caring for a patient with systemic lupus erythematosus (SLE). Which cardiopulmonary manifestations should the nurse closely monitor for? Select all that apply. a. Cough b. Tachypnea c. Hypotension d. Dysrhythmias e. Hypocholesterolemia

ANS: A B D Cough and tachypnea suggest lung disease in a patient with SLE. Dysrhythmias may also occur due to fibrosis of the sinoatrial and atrioventricular nodes. Other cardiopulmonary changes seen in patients with SLE include hypertension and hypercholesterolemia.

A patient reports to the primary care clinic after being diagnosed with systemic lupus erythematosus (SLE). The patient's blood pressure is 175/90 mmHg. What does the nurse expect the healthcare provider to recommend? Select all that apply. a. low-sodium diet b. Complete metabolic panel c. Weight loss and high-intensity daily exercise d. Aggressive antihypertensive therapy with oral medications e. Referral to the emergency room for blood pressure management

ANS: A B D Patients with SLE need to have comorbid hypertension managed aggressively with frequent monitoring, oral antihypertensive therapy, a complete metabolic panel to evaluate for hypercholesterolemia, and a low-sodium diet. Referral to the emergency room for hypertensive patients is reserved for patients with hypertensive urgency or emergency, which is not the case with this patient. Weight loss may be indicated; however, high-intensity daily exercise should be avoided in patients with SLE since physical stress can cause flares.

A pregnant patient is diagnosed with systemic lupus erythematosus (SLE). Which information about associated complications should the nurse give to the patient? Select all that apply. a. Intrauterine growth retardation b. Stillbirth and spontaneous abortion c. Aggravation of disease due to pregnancy d. High maternal and fetal risk due to organ involvement e. Therapeutic termination recommended in majority of cases

ANS: A B D SLE is characterized by the production of a large variety of autoantibodies against nucleic acids and various self-proteins and internal organ involvement posing a threat to the fetus and the mother. The SLE patient should understand that spontaneous abortion, stillbirth, and intrauterine growth retardation may occur because of deposits of immune complexes in the placenta and because of inflammatory responses in the placental blood vessels. There is a high maternal and fetal risk due to organ involvement of renal, cardiovascular, pulmonary, and central nervous systems. Exacerbation of the disease is common during the postpartum period. If proper therapeutic management and monitoring is done, therapeutic termination may not be required, and the patient can give birth to a healthy baby.

A patient is admitted to the hospital for further management of a systemic lupus erythematosus (SLE) flare. What actions does the nurse anticipate performing in the care of this patient? Select all that apply. a. Obtain weight daily. b. Observe and record intake and output. c. Administer 2 L supplemental oxygen via nasal cannula. d. Administer 125 mg methylprednisolone intravenously every six hours. e. Administer 2 mg hydromorphone intravenously (IV) as needed for pain rated 7 to 10.

ANS: A B D E Treatment of an acute flare primarily involves symptom relief. Pain is often associated with disease flares, particularly in the joints, and it may be treated with IV analgesics like hydromorphone. IV corticosteroids like methylprednisolone are often used to reduce inflammation and treat acute disease flares. Both accurate measurement of input/output and daily weights are important for the patient being treated with IV corticosteroids since there is a possibility of fluid retention and renal failure. Supplemental oxygen is not indicated solely on the basis of treating an SLE flare but could be indicated after further workup or if the patient becomes hypoxemic.

A patient is diagnosed with systemic lupus erythematosus (SLE). What neurologic manifestations should the nurse closely monitor for? Select all that apply. a. Stroke b. Seizures c. Alopecia d. Synovitis e. Psychosis

ANS: A B E Stroke, seizures, and psychosis are neurologic manifestations of SLE. Alopecia is an integumentary manifestation of SLE. Synovitis is a musculoskeletal manifestation of SLE.

What environmental factors are believed to contribute to the occurrence of systemic lupus erythematosus (SLE)? Select all that apply. a. Stress b. Hormones c. Viral infections d. Ultraviolet (UV) light exposure e. Exposure to chemicals and toxins

ANS: A C D E Environmental exposure to some chemicals or toxins, UV light, viral infections, and stress can stimulate immune hyperactivity which may trigger SLE. Hormones are also known to play a role in the etiology of SLE, but they are not an environmental factor.

A patient has recently been diagnosed with systemic lupus erythematosus (SLE). A nurse is educating the patient about common complications of this disorder, noting that it most commonly affects which body systems? Select all that apply. a. Urologic b. Hematologic c. Neurologic d. Integumentary e. Musculoskeletal f. Cardiopulmonary

ANS: A C D E F In SLE, the most commonly affected tissues are those of the heart and lung lining (cardiopulmonary), muscles (musculoskeletal), skin (integumentary), nervous tissue (neurologic), and the kidneys (urologic). Hematologic complications such as anemia can also occur, but these are less common.

Which diagnostic laboratory studies are utilized in the evaluation of systemic lupus erythematosus (SLE)? Select all that apply. a. Urinalysis b. Chest x-ray c. Serum complement d. Electrocardiogram (ECG) e. Complete blood cell count (CBC)

ANS: A C E A CBC, serum complement, and urinalysis are all diagnostic laboratory studies used to evaluate SLE. A chest x-ray and an ECG are useful in diagnostic assessment of SLE, but these are not laboratory studies.

A patient is prescribed an antimalarial agent for the treatment of systemic lupus erythematosus (SLE) and states, "I don't have malaria. Why am I taking this" What is the best response by the nurse? Select all that apply. a. To treat fatigue b. To treat hypercoagulability c. To improve cutaneous lupus d. To treat exacerbations of polyarthritis e. To treat moderate skin and joints disease

ANS: A E Antimalarial agents such as hydroxychloroquine and chloroquine are often used to treat fatigue and moderate skin and joints problems in SLE patients. In cases of hypercoagulability, an anticoagulant such as warfarin or heparin is used. For cutaneous lupus, high doses of corticosteroids or thalidomide are used. In order to treat exacerbations of polyarthritis, nonsteroidal antiinflammatory drugs are given.

A patient with systemic lupus erythematosus (SLE) inquires why it is important to have frequent urinalysis done. How should the nurse respond? Select all that apply. a. "Kidney damage is very common in people with SLE." b. "Renal involvement in SLE is often a late effect of the disease." c. "Renal involvement with SLE is a minor complication of the disease." d. "This is probably an error. You do not need to have this testing frequently." e. "Urinalysis will evaluate for proteinuria, which may be an early sign of renal complications."

ANS: A E More than 75% of patients with SLE have some form of renal involvement, varying from mild proteinuria to end-stage renal disease. This means frequent urinalysis is not an error. Manifestations of renal involvement are usually evident within two years after diagnosis. Renal involvement and associated sequelae represent the leading cause of death for patients with SLE, so this is not considered a minor complication.

A patient has been taking an antimalarial drug prescribed for systemic lupus erythematosus (SLE) but is unable to tolerate the side effects. What medication does the nurse anticipate educating the patient about that would be an alternate? a. Uricosuric drug b. Antileprosy drug c. Steroid-sparing drug d. Antiinflammatory drug

ANS: B If the patient with SLE cannot tolerate an antimalarial agent, an antileprosy drug such as dapsone may be used. Uricosuric drugs are used to treat gout. Steroid-sparing drugs such as methotrexate are used in treating SLE, but not as an alternative to antimalarial drugs. These are given to decrease the side effects of corticosteroids. Antiinflammatory drugs are pain relievers and reduce inflammation.

What marker is found in a majority of patients diagnosed with systemic lupus erythematosus (SLE)? a. C-reactive protein (CRP) b. Antinuclear antibody (ANA) c. Carcinoembryonic antigen (CEA) d. Erythrocyte sedimentation rate (ESR)

ANS: B Of those diagnosed with SLE, 97% have ANA in their blood. ESR and CRP are markers of inflammation that may be used to monitor disease activity and effectiveness of therapy. CEA is a blood marker that is useful in diagnosing some cancers; it is unrelated to SLE.

To diagnose a patient with systemic lupus erythematosus (SLE), the patient must meet how many of the distinct criteria either simultaneously or in sequential evaluation? a Three b. Four c. Five d. Six

ANS: B Patients are diagnosed with SLE if they have four of the criteria for the disease either simultaneously or in sequential observation since there is no specific diagnostic test for SLE. Meeting three is too few, and meeting five or six is subsumed in meeting four.

A patient with systemic lupus erythematosus has developed osteoporosis related to the disease process. Which drug therapy does the nurse anticipate the patient will be prescribed? a. Tacrolimus b. Prasterone c. Azathioprine d. Pimecrolimus

ANS: B Prasterone is a hormone used to treat lupus-induced osteoporosis. Tacrolimus and pimecrolimus are used to treat integumentary symptoms of butterfly rash and discoid lesion in systemic lupus erythematosus (SLE). Azathioprine is used to reduce the need for long-term corticosteroid therapy in SLE patients.

When caring for a patient with systemic lupus erythematosus, the nurse recognizes which major and serious complication of the disorder? a. Dysphagia b. Renal failure c. Peripheral neuropathies d. Multiple open skin lesions

ANS: B The multisystem nature of systemic lupus erythematosus (SLE) places the patient at risk for multiple complications and is ultimately fatal. Renal failure is one of the major and serious complications of SLE. Although dysphagia, peripheral neuropathies, and multiple open skin lesions may be present in the patient with SLE, they are not consistently present and are not as serious as renal failure.

A patient with systemic lupus erythematosus (SLE) reports a persistently erythematous rash over the cheeks and the bridge of the nose. The rash appeared after spending a day outside at a theme park. What is the priority action by the nurse? a. Instruct the patient to apply aloe vera to the affected area. b. Educate the patient that this is not unexpected for someone with SLE. c. Reassure the patient that this is likely sunburn and will fade after a few days. d. Instruct the patient to proceed to the emergency room for immediate evaluation.

ANS: B Vascular lesions commonly develop in sun-exposed areas in those who have SLE, with 55% to 85% of patients developing a butterfly rash over the cheeks and the bridge of the nose at some point during the disease. This is an expected manifestation of SLE and does not pose a life-threatening risk, so the patient does not need to proceed to the emergency room. This may be a photosensitive reaction but is unlikely sunburn, which also means it would unlikely be relieved with aloe vera treatments.

A patient asks why they have to continue to take oral prednisone for the treatment of systemic lupus erythematosus (SLE). What is the best response by the nurse? Select all that apply. a. To treat fatigue b. To control seizures c. To treat lupus nephritis d. To manage polyarthralgia e. To treat hypercoagulability

ANS: B C Prednisone is a corticosteroid drug. In patients with SLE, corticosteroids are given to treat seizures. Prednisone is also used in the treatment of lupus nephritis, especially when the cytotoxic drugs have not yet achieved therapeutic effectiveness. Antimalarials are often used to treat fatigue in SLE patients. Nonsteroidal antiinflammatory drugs are used in cases of polyarthralgias. Hypercoagulability is managed with the help of anticoagulants such as warfarin or heparin.

A patient with systemic lupus erythematosus (SLE) is experiencing many psychosocial issues. How should the nurse educate the patient to help overcome this problem? Select all that apply. a. Ask patient to indulge in outdoor activities. b. Advise a consultation with a dermatologist. c. Counsel the patient that the disease has a good prognosis. d. Stress the planning of both recreational and occupational activities. e. Ask the patient to ignore the underlying symptoms of disease and concentrate on a hobby.

ANS: B C D At the onset, the symptoms of SLE may be vague, and therefore supportive therapies may become as important as medical treatment in helping the patient cope with the disease. Generation of faith toward the therapy psychologically heals the patient and generates the will to continue the therapy. Symptoms like skin lesions and alopecia may lead to social isolation and can be treated by a dermatologist. Careful planning of occupational and recreational activities can give a purpose to the patient's life. However, neglecting the disease symptoms doesn't reduce the severity of disease and should be reported. Indulging in outdoor activities is not advisable, because the patient is photosensitive.

The nurse is educating a patient newly diagnosed with systemic lupus erythematosus (SLE). What should the nurse include in the education about things to avoid? Select all that apply. a. Pregnancy b. Physical and emotional stress c. Exposure to individuals with infections d. Nonsteroidal antiinflammatory medications e. Drying soaps, powders, and household chemicals

ANS: B C E Drying soaps, powder, and household chemicals will all exacerbate symptoms in the integumentary system. Exposure to individuals with infections should be limited, since those with SLE are often immunocompromised or taking immunosuppressant drugs. Avoidance of physical and emotional stress may help reduce SLE flares. Nonsteroidal antiinflammatory drugs are a mainstay of treatment for arthralgias in SLE. Pregnancy is safe for those with mild to moderate SLE but should be done in consultation with a physician.

A nurse is caring for a patient with systemic lupus erythematosus (SLE) who is taking nonsteroidal antiinflammatory drugs (NSAIDs) for joint pain. Which adverse effects of NSAID therapy should the nurse educate the patient about? Select all that apply. a. Fever b. Pallor c. Tingling d. Petechiae e. Tarry stools

ANS: B D E Tarry stools are a sign of blood in the gastrointestinal tract, presence of petechiae is a sign of subcutaneous hemorrhage, and pallor may be a sign of decreased hematocrit, all of which can be caused by bleeding as a result of NSAID therapy. The patient with SLE should be educated about all of these possible drug adverse effects. Tingling is a symptom of peripheral neuropathy, which may be related to SLE itself or caused by irritated nerve endings in an acute flare. Fever is likely a sign of underlying infection. Neither of these manifestations is related to NSAID therapy.

A patient with systemic lupus erythematosus (SLE) returns to the clinic with worsening fatigue. On intake, the nurse notices that the patient has a sunburn and malar rash. What will the nurse document? Select all that apply. a. Fatigue related to active infection b. Fatigue related to chronic inflammation c. Poor compliance related to knowledge deficit d. Impaired skin integrity related to medication usage e. Impaired skin integrity related to photosensitivity and skin rash

ANS: B E Impaired skin integrity related to photosensitivity and skin rash as well as fatigue related to chronic inflammation are two nursing diagnoses that pertain to this patient with SLE. Impaired skin integrity is evident, but the nurse cannot know without further assessment if it is related to medication therapy. Poor compliance is evident but may be caused by a variety of reasons; the knowledge deficit must first be assessed. The nurse cannot diagnose fatigue related to active infection without fully assessing the patient.

A woman with systemic lupus erythematosus (SLE) who is one-month postpartum reports to the emergency room with fever, malaise, and severe pain for two days. She had been discharged from the hospital with similar symptoms one week ago. What is the most likely reason for readmission? a. The patient is likely opioid-seeking. b. The patient's SLE is poorly controlled. c. SLE flares are common in the postpartum period. d. The patient is exhausted from caring for a new baby.

ANS: C

A common diagnostic feature of systemic lupus erythematosus (SLE) is the malar rash, which is characterized by what features? a. Painless oral ulcerations b. Skin rash as an unusual reaction to light c. Fixed erythema, flat or raised, usually in a butterfly pattern d. Raised patches with scaling follicular plugging and scarring in older lesions

ANS: C A malar rash is a fixed erythema that is either flat or raised, also known as a butterfly rash. Raised patches with scaling follicular plugging is associated with discoid rash, which is also found in SLE; Photosensitivity is a skin rash as an unusual reaction to light which can be found in SLE. Painless oral ulcerations are also a hallmark of SLE but are not a feature of the malar rash.

A patient with systemic lupus erythematosus (SLE) arrives at a rheumatology clinic with persistent facial lesions, photosensitivity, polyarthralgia, and mild proteinuria. The nurse knows these symptoms constitute which syndrome? a. Acute cutaneous lupus b. Acute systemic lupus flare c. Subacute cutaneous lupus d. Subacute drug-induced lupus

ANS: C A small number of SLE patients have persistent lesions, photosensitivity, polyarthralgia, and mild systemic disease in a syndrome known as subacute cutaneous lupus. Drug-induced lupus is related to medication administration. Lupus flare is characterized by acute decompensation. Polyarthralgia and mild proteinuria would constitute mild systemic disease, making this subacute, not acute.

A patient with an acute systemic lupus erythematosus (SLE) flare is tearful and anxious. What is the most appropriate action of the nurse? a. Assist the patient with turning and repositioning. b. Page the doctor for intravenous (IV) Ativan, 2 mg. c. Hold the patient's hand and provide emotional support. d. Page the doctor for intravenous (IV) hydromorphone, 2 mg.

ANS: C Chronic illnesses, especially SLE with its multiple flares, can be a particularly stressful situation for many patients. Providing emotional support is paramount to successful disease management, particularly in acute flares. IV opioids such as hydromorphone may be necessary to provide analgesia for pain associated with an acute flare, but the nurse should first provide emotional support and comfort. Assisting the patient with comfort may be necessary after addressing the patient's anxiety. IV anxiety medications may be necessary but are generally reserved for profound anxiety or psychosis associated with disease a flare.

The nurse is educating a patient with systemic lupus erythematosus (SLE) about precipitating factors of the disease. Which precipitating factors should the nurse be sure to include when discussing them? a. Azathioprine, hydralazine, and procainamide b. Procainamide, chloroquine, and sun exposure c. Sun exposure, hydralazine, and oral contraceptives d. Cyclophosphamide, oral contraceptives, and azathioprine

ANS: C In SLE patients, the onset or exacerbation of disease symptoms sometimes occurs due to sun exposure. SLE may also be precipitated or aggravated by certain drugs, such as hydralazine and oral contraceptives. Azathioprine is used as a treatment drug in SLE. Procainamide can also precipitate SLE. However, chloroquine is used to treat fatigue and moderate skin and joint problems in patients with SLE. Cyclophosphamide and azathioprine are used to treat SLE.

A patient was started on hydralazine for hypertension after a recent hospitalization. The patient is accompanied by a parent who has systemic lupus erythematosus (SLE). What is the best intervention by the nurse? a. Alert the healthcare provider to screen for SLE. b. Tell the patient to immediately discontinue taking the hydralazine. c. Alert the healthcare provider to the medication and family history. d. Educate the patient that family history of SLE does not increase risk for this disease.

ANS: C Many drugs may trigger SLE, the most common being procainamide, hydralazine, and quinidine. While the exact etiology of the disease is unknown, there is a high prevalence of SLE among family members, and a genetic link is suspected. Therefore, the nurse should alert the physician to these factors. The patient should not be told that family history does not increase risk, as this is incorrect. Hydralazine is a medication that treats hypertension, and patients should not stop or change medications without consulting their physicians. There is no specific screening tool for this disease that would be done on an annual basis.

A patient with suspected systemic lupus erythematosus (SLE) has persistent lesions along with malar rashes, photosensitivity, and mild systemic disease. Which syndrome does the nurse document? a. Felty syndrome b. Antiphospholipid antibody syndrome c. Subacute cutaneous lupus syndrome d. Chronic fatigue and immune dysfunction syndrome

ANS: C Persistent lesions, photosensitivity, and mild systemic diseases are characteristics of subacute cutaneous lupus syndrome. It is found in a small number of patients with SLE. Felty syndrome, characterized by splenomegaly and leukopenia, is found in patients with severe, nodule-forming rheumatoid arthritis. Antiphospholipid antibody syndrome is a coagulation disorder in SLE patients. It leads to clots in veins and arteries. Chronic fatigue and immune dysfunction syndrome is another name for chronic fatigue syndrome. It is a poorly understood disorder characterized by debilitating fatigue and a variety of associated complaints.

A patient voices concerns to the nurse about taking procainamide, stating that a friend was recently hospitalized for drug-induced systemic lupus erythematosus (SLE). What is the nurse's best response? a. "Procainamide is not typically associated with drug-induced SLE." b. "If this hasn't occurred yet, there is no continued risk of drug-induced SLE." c. "Drug-induced SLE generally occurs months to year after continuous use of this drug." d. "Drug-induced SLE is a common side effect of medication therapy, particularly this medication."

ANS: C SLE can occur months to years after continuous therapy with causative drugs. Drug-induced SLE is not considered a medication side effect, which generally occurs hours to days after initiating therapy with a particular medication. Drug-induced SLE may take months or years to develop, so the risk persists. Procainamide, hydralazine, and quinidine are the most frequently identified medications that cause drug-induced SLE.

Which patient should the nurse expect to be at the highest risk for systemic lupus erythematosus (SLE)? a. A 24-year-old white female b. A 55-year-old Hispanic male c. A 28-year-old Asian American female d. A 30-year-old African American male

ANS: C SLE is a complex disorder affecting 250,000 people in the United States, with women 6 to 10 times more likely to develop this disorder than men. The Asian American female is at a higher risk for SLE than the African American and Hispanic males because she is female. She is also at a higher risk than the white female because white females are at a lower risk than Asian American females.

A patient with systemic lupus erythematosus (SLE) is brought to the emergency room by ambulance after a grand mal seizure. The patient's family is visibly distraught, wondering if the patient is going to be diagnosed with another chronic medical disease. What is the nurse's best response? a. "Seizures are caused by epilepsy; this is not related to SLE." b. "Seizures are a common occurrence in SLE; this is nothing to worry about." c. "Seizures are a common occurrence in SLE but can ideally be managed with oral medications." d. "Seizures are extremely rare in patients with SLE; the patient will need a further workup to determine the cause of the seizure."

ANS: C Seizures occur in as many as 15% of patients with SLE by the time of diagnosis and are generally controlled with corticosteroids or antiseizure drugs. Seizures will indicate a further workup but are common with SLE. Seizures can represent a life-threatening insult and should be closely monitored. Seizures have a multitude of causes, including but not limited to epilepsy and latent effects of SLE.

A patient's complex symptomatology over the past year has led to a diagnosis of systemic lupus erythematosus (SLE). Which statement demonstrates the patient's need for further teaching about the disease? a. "I'll try my best to stay out of the sun this summer." b. "I know that I probably have a high chance of getting arthritis." c. "I'm hoping that surgery will be an option for me in the future." d. "I understand that I'm going to be vulnerable to getting infections."

ANS: C Surgery is not a key treatment modality for SLE, so this indicates a need for further teaching. SLE carries an increased risk of infection, sun damage, and arthritis.

A patient with systemic lupus erythematosus (SLE) reports a low-grade fever and malaise. What response by the nurse would be the mostappropriate? a. "Do you have a cough?" b. "This is probably a result of the SLE and not an infection." c. "Please schedule a sick visit with the healthcare provider." d. "Patients with SLE are at a lower risk for infections than the general population."

ANS: C The patient should see his or her healthcare provider. Patients with SLE have increased susceptibility to infection, which is a major cause of death in patients with this disorder, making prompt evaluation prudent. Patients with SLE appear to be at a higher risk of infections, perhaps due to impaired ability to phagocytize invading bacteria or deficient production of antibodies. Fever is generally an indication of underlying infection and not caused by the SLE itself. Pneumonia, which includes coughing as a symptom, is the most common infection in those with SLE. However, evaluation of patient's symptoms should be done by a healthcare provider in a timely manner.

A patient informs the nurse that the appearance of a malar rash is concerning. What is the most appropriate response to this patient regarding treatment options? a. "Intravenous (IV) corticosteroids will reverse this symptom." b. "Oral corticosteroids will help treat the appearance of this rash." c. "Topical immunomodulators can be used instead of corticosteroids to treat serious skin conditions." d. "Nonsteroidal antiinflammatory drug (NSAID) medications will reduce the inflammation near the rash."

ANS: C Topical immunomodulators can be used instead of corticosteroids to treat serious skin conditions by suppressing immune activity in the skin, affecting the butterfly rash. Oral corticosteroid use should be limited if possible. NSAIDs are an effective treatment for arthralgia associated with SLE. IV corticosteroids should be limited to acute SLE flares.

The nurse is caring for a patient with systemic lupus erythematosus. To prevent an exacerbation of the condition, what should the nurse instruct the patient to avoid? a. Dairy products b. Animal dander c. Becoming fatigued d. Nonsteroidal drugs

ANS: C When lupus erythematosus is active, the nurse should teach the patient ways to minimize fatigue, sun exposure, emotional stress, and infection to decrease the risks of exacerbation. Systemic lupus erythematosus is an immune disorder; exacerbations are not linked to animal dander, dairy products, or nonsteroidal drugs.

A patient reports to a rheumatology clinic with a swan neck deformity of the fingers of the left hand and is referred for laboratory testing for systemic lupus erythematosus (SLE). The patient calls back several days later saying, "The healthcare provider must be wrong. This has to be arthritis like my mother has." What is the nurse's best response? a. Reassure the patient that SLE will not affect all the joints like arthritis. b. Reassure the patient that SLE has a good prognosis in most patients. c. Explain that arthritis is not the only medical condition that can cause joint deformities. d. Reassure the patient that the inflammation in the hand is temporary and oral steroids will treat SLE and reverse the damage to the hand.

ANS: C While SLE is generally nonerosive, it can cause deformities, ulnar deviation, and subluxation with joint laxity. Swan neck deformities are permanent changes to the joint from arthritis, but arthritis is not the only cause of joint deformities. Symptoms can be managed with steroids, but damage will not be reversed. SLE does have a good prognosis in most patients; however, this patient has not been diagnosed at this time. SLE can affect any joint.

During an appointment, a patient with systemic lupus erythematosus (SLE) and suspected lung disease says she is interested in getting pregnant. How should the nurse best counsel the patient? a. "Many women with SLE have some infertility related to the disease." b. "Women with SLE are at higher risk for spontaneous abortion and stillbirth." c. "Women with advanced SLE should consider alternative family-building options." d. "This is an exciting time; talk to the doctor about the possibility of flares after delivery."

ANS: C Women with advanced SLE should be counseled against pregnancy; this patient presents with suspected lung disease related to SLE, which represents advanced disease. Women with SLE do have increased risk for postpartum flares; however, this is not the priority concern given the patient's advanced disease status. Women with SLE can have difficulty conceiving and a higher risk of spontaneous abortion and stillbirth, but counseling against pregnancy is the priority since this patient has advanced disease.

After a patient is diagnosed with systemic lupus erythematosus (SLE), the nurse educates the patient on the effects of sunlight on the disease. What is the best way for the nurse to do this? a. Supports the patient by holding his or her hand b. Helps the patient set reasonable goals for improving energy c. Educates the patient on the importance of planning outdoor activities d. Gives the patient brochures and literature that explain the importance of medication compliance

ANS: C Young people in particular may have difficulties with sun restrictions in treating SLE; educating them on planning ahead for outdoor activities to prevent complications while maintaining their psychosocial integrity may go a long way toward long-term compliance. Brochures may be helpful to highlight medication adherence; however, supportive therapies are often just as important as medication therapies in the treatment of SLE. One mainstay of treatment for SLE is to help patients set reasonable goals to improve energy; however, this is not related to the effects of sunlight. Supportive therapy is often as important as medication therapy in helping patients with SLE cope with their condition; however, this is not related to sunlight.

A patient with systemic lupus erythematosus (SLE) has comorbid hypertension and hypercholesterolemia. The nurse educates the patient that he or she is at risk for secondary antiphospholipid syndrome, which could have which effect(s)? a. Increased risk of peripheral neuropathy b. Increased risk of fracture and bone loss c. Increased risk of stroke, heart attack, and gangrene d. Increased risk of lung disease, especially pneumonia

ANS: D

The nurse is performing neurologic assessments for a patient with systemic lupus erythematosus (SLE) every four hours. After several examinations, the patient asks why this is necessary. What is the nurse's best response? a. "I'm sorry that I have disturbed you with these assessments. I will be sure to come back later." b. "This is clearly an error on the part of the healthcare provider. Let me call them for a correction." c. "Disease flare and treatment may cause changes only in the peripheral nervous system (PNS)." d. "Central nervous system (CNS) disorders are common in SLE, so frequent monitoring is important."

ANS: D CNS involvement and seizure can occur with this disease but can also be caused by treatment, so monitoring is of utmost importance. Both disease flare and intravenous corticosteroids can cause CNS, not just PNS, alterations, so patients should be monitored for vision problems, headaches, personality changes, seizures, and memory loss. The physician has not made an error. Explaining treatments and rationale to the patient is important during an acute flare of disease, so the nurse should not dismiss the patient's questions and leave.

Which is an immunosuppressive agent used to treat lupus nephritis in systemic lupus erythematosus (SLE) patients? a. Allopurinol b. Pilocarpine c. Chloroquine d. Cyclophosphamide

ANS: D Cyclophosphamide is a cytotoxic immunosuppressive agent that is used for the treatment of lupus nephritis in SLE. Allopurinol is a uricosuric agent used in the treatment of gout. Pilocarpine is used in the treatment of Sjogren's syndrome because it stimulates saliva production. Chloroquine is an antimalarial agent often used to treat fatigue and moderate skin and joint problems in SLE.

The nurse is reviewing laboratory findings for a patient which demonstrate an increased serum creatinine, leukopenia, thrombocytopenia, the presence of anti-DNA antibody, and increased erythrocyte sedimentation rate (ESR). What does the nurse suspect the likely diagnosis may be? a. Psoriasis b. Scleroderma c. Lyme disease d. Systemic lupus erythematosus (SLE)

ANS: D Increased serum creatinine, leukopenia, thrombocytopenia, the presence of anti-DNA antibody, and an increased ESR are seen in patients with SLE. In psoriasis, ESR is elevated but anti-DNA antibody is not found. In scleroderma, there may be elevated creatinine levels and mild hemolytic anemia but leukopenia and thrombocytopenia are not seen. Complete blood count and ESR are usually normal in Lyme disease.

A woman with systemic lupus erythematosus (SLE) reports to the clinic that she has been attempting pregnancy for six months without success. What is the nurse's most appropriate response? a. "Stillbirth is common in women with SLE." b. "Women with SLE should never become pregnant." c. "SLE causes many birth defects but should not affect fertility." d. "Infertility can result from the SLE or from medications used to treat it."

ANS: D Infertility can result from renal involvement and previous use of high-dose corticosteroid or immunosuppressive drugs. SLE can also commonly cause intrauterine growth retardation from immune complexes that are deposited in the placenta. Saying that SLE does not affect fertility is incorrect. Women with mild SLE can safely become pregnant, but there are risks to the mother and the fetus, so this should be undertaken in consultation with either a rheumatologist and/or an obstetrician. Both spontaneous abortion and stillbirth are common in SLE, but these are not factors that affect fertility.

The nurse is performing an assessment for a pregnant patient with systemic lupus erythematosus (SLE) that has just had an ultrasound. Which complication should the nurse be sure to assess for in this patient? a. Systemic sclerosis b. Erythema migrans c. Restless leg syndrome d. Intrauterine growth restriction

ANS: D Intrauterine growth retardation is a common problem with pregnancy in SLE patients. It occurs because immune complexes are deposited in the placenta and because inflammatory responses take place in the placental blood vessels. Systemic sclerosis is another name for scleroderma. Erythema migrans is a sign of Lyme disease. Restless leg syndrome is an irresistible urge to move the legs when at rest or lying down. It is typically seen in patients with fibromyalgia.

A patient is newly diagnosed with systemic lupus erythematosus (SLE) and reports joint pain. Which class of medication does the nurse anticipate educating the patient about that can relieve the pain? a. Corticosteroids b. Steroid-sparing drugs c. Immunosuppressive drugs d. Nonsteroidal antiinflammatory drugs (NSAIDs)

ANS: D NSAIDs are a mainstay of treatment for patients with mild arthralgia or arthritis related to SLE. Use of corticosteroids should be limited but may help manage severe flares of polyarthritis or severe disease. Steroid-sparing drugs can serve as alternate therapy to corticosteroids. Immunosuppressive drugs may be used to decrease the need for long-term corticosteroids or to treat severe organ-system disease related to SLE.

Which patient diagnosed with systemic lupus erythematous (SLE) is at the highest risk for experiencing health care disparity? a. A white female b. A Hispanic male c. An African American male d. An African American female

ANS: D SLE is more common in females, and the disease presentation is more severe among African American, Hispanic, Asian American, and Native American women than in white women. African American females have a higher risk for experiencing health care disparities than do white females, Hispanic males, or African American males.

A woman with advanced systemic lupus erythematosus (SLE) who suffers from profound kidney and lung dysfunction would like to become pregnant. Based on the nurse's knowledge of SLE, what can the nurse tell the patient? a. "SLE will not affect pregnancy at all." b. "Flares are common during pregnancy." c. "SLE will not prevent you from becoming pregnant." d. "Women with profound effects from SLE should not become pregnant."

ANS: D Since SLE will affect the renal, cardiovascular, pulmonary, and central nervous systems in pregnancy, women who already have had serious effects on these systems should be counseled against becoming pregnant. SLE can cause infertility. Flares are common in the postpartum period, not during pregnancy. SLE can also cause spontaneous abortion, stillbirth, and intrauterine growth retardation.

A patient with systemic lupus erythematosus (SLE) has persistent proteinuria, for which the healthcare provider prescribed both oral steroids and a cytotoxic agent. When the patient asks why two medications are necessary, what is the nurse's best response? a. "Oral steroids are likely a mistake; take only the cytotoxic agent." b. "Both agents combined will help slow the progression of further kidney damage." c. "Oral steroids must be used to decrease inflammation in the kidney and reverse damage." d. "Oral steroids are used in the initial treatment period while the cytotoxic agent takes effect."

ANS: D The primary goal of treatment for SLE with renal involvement is to slow the progression of renal damage by treating the underlying disease, which is usually accomplished with oral steroids, cytotoxic agents, and immunosuppressive agents. Corticosteroids are common until cytotoxins or immunosuppressants take effect. Oral steroids are unlikely to reverse damage already done in the kidney but can slow further progression. Corticosteroid use should be limited as much as possible and is usually only in the initial phase of this treatment. Patients should be educated to take all medications as prescribed; the nurse should not tell the patient this is a mistake without consulting the prescribing provider.

Which disorders may cause peripheral neuropathy? Select all that apply. a. Fibromyalgia b. Osteoarthritis c. Dermatomyositis d. Rheumatoid arthritis e. Systemic lupus erythematosus (SLE)

ANS: D E Peripheral neuropathy, or irritation of the nerves of the extremities, may occur in SLE and rheumatoid arthritis. Fibromyalgia is a musculoskeletal disorder that does not cause neuropathy. Osteoarthritis is a localized disease with a variable, progressive course; it does not cause neuropathy. Dermatomyositis is characterized by muscle changes along with significant skin changes, but not peripheral neuropathy.