Systemic Lupus Erythematosus
Which statement by a patient with systemic lupus erythematosus (SLE) indicates the patient has understood the nurse's teaching about the condition? "I will exercise even if I am tired." "I will use sunscreen when I am outside." "I should avoid nonsteroidal antiinflammatory drugs." "I should take birth control pills to avoid getting pregnant."
"I will use sunscreen when I am outside." Severe skin reactions can occur in patients with SLE who are exposed to the sun. Patients should 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.
A female patient presents to the primary care clinic with a reddened, raised rash over her nose and cheeks. The patient also complains about painful joints in her left hand. Which laboratory tests would the nurse anticipate being ordered by the provider to confirm a diagnosis of systemic lupus erythematosus (SLE)? Select all that apply. Anti-DNA antibody test Complete blood count (CBC) Antiphospholipid antibody test Antinuclear antibody (ANA) test Determination of the erythrocyte sedimentation rate (ESR)
Anti-DNA antibody test Antiphospholipid antibody test Antinuclear antibody (ANA) test Anti-DNA antibody test results are positive in half of the patients with a confirmed diagnosis of SLE. Thus this laboratory test would be ordered for a patient with a butterfly rash.Antiphospholipid antibodies are found in patients with SLE. Therefore this laboratory test would be ordered for a patient with a characteristic butterfly rash on the face.An ANA test is performed when a patient presents with symptoms of SLE. About 97% of patients with SLE have a positive ANA test result. A CBC would be ordered for a patient with a butterfly rash, but its results are not indicative of SLE, because other reasons for an abnormal CBC may exist.A determination of the ESR would be ordered for a patient with a rash over the nose and cheeks. However, the ESR will be elevated in other rheumatic conditions, as well as SLE, and will not help confirm the diagnosis.
A new clinic patient with joint swelling and pain is being tested for systemic lupus erythematosus. Which test will provide the most specific findings for the nurse to review? Rheumatoid factor (RF) Antinuclear antibody (ANA) Anti-Smith antibody (Anti-Sm) Lupus erythematosus (LE) cell prep
Anti-Smith antibody (Anti-Sm) 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.
Which result for a patient with systemic lupus erythematosus (SLE) is most important for the nurse to communicate to the health care provider? Decreased C-reactive protein (CRP) Elevated blood urea nitrogen (BUN) Positive antinuclear antibodies (ANA) Positive lupus erythematosus cell prep
Elevated blood urea nitrogen (BUN) 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.
A patient is undergoing diagnostic testing for suspected systemic lupus erythematosus (SLE). Which assessment findings may help confirm the diagnosis? Select all that apply. Malar rash Photosensitivity Painful sores in the oral cavity Decreased white blood cell count Multiple swollen and painful joints
Malar rash Photosensitivity Multiple swollen and painful joints A patient is diagnosed with SLE when he or she has four or more symptoms. One of the symptoms is a malar rash on the face.At least four specific SLE-related symptoms are required for a diagnosis of SLE. One of the symptoms is sensitivity to natural or artificial light.Pain in two or more joints is one of the four diagnostic criteria for SLE. Painless, not painful, mouth ulcers are included in the list of symptoms of SLE.One finding in SLE is leukocytosis, which is an increased, not a decreased, white blood cell count.
Which plasma proteins and blood cells are affected by the autoimmune response in systemic lupus erythematosus (SLE)? Select all that apply. Platelets Lymphocytes Clotting factors Pleural fluid cells Antinuclear antibodies
Platelets Lymphocytes Clotting factors Platelets are cells that help with blood clotting. They are affected by the autoimmune response in SLE.Lymphocytes are white blood cells that are affected by the autoimmune response in the disease process of SLE.Clotting factors are plasma proteins that are affected by the autoimmune response in SLE.
Which finding in a patient with systemic lupus erythematosus (SLE) would indicate possible kidney damage? Dark amber urine Protein in the urine Glucose in the urine Increased urine output
Protein in the urine Proteinuria is a common finding in patients with SLE and indicates possible kidney damage. Dark amber urine indicates decreased oral intake, not kidney injury. Glucose is found in patients with diabetes mellitus, but not in those with SLE. A patient with possible kidney damage may have a decreased, not an increased, urine output.
Which factor could trigger an exacerbation of systemic lupus erythematosus (SLE)? Onset of menopause Family history of SLE Ultraviolet (UV) light exposure Use of acetaminophen for arthritis pain
Ultraviolet (UV) light exposure Patients with SLE are photosensitive, and their exposure to light, including the sun and UV light, can exacerbate the disease. A butterfly rash over the nose and cheeks would develop after exposure. The hormones of the menstrual cycle and pregnancy can exacerbate SLE. Menopause would not exacerbate this disease because it is a time when menstrual periods stop permanently and the production of hormones is decreased.Having a family history of SLE can increase an individual's risk of developing the disease; however, it would not cause an exacerbation.Acetaminophen is a mild analgesic that is used in managing pain related to arthritis. It is not among the 40 prescription drugs that can cause or exacerbate SLE.
A patient with systemic lupus erythematosus (SLE) mentions to the nurse that she is trying to conceive. Which questions should the nurse ask to address potential pregnancy complications? "Is this your first pregnancy?" "Are you currently taking methotrexate?" "Have you had an antiphospholipid antibody test?" "How long have you and your partner been trying to conceive?" "Have you and your partner started pregnancy counseling?"
"Are you currently taking methotrexate?" "Have you had an antiphospholipid antibody test?" "Have you and your partner started pregnancy counseling?" Methotrexate is a medication used to manage SLE symptoms that can cause birth defects or miscarriages. The patient should know about the side effects of methotrexate if she is trying to become pregnant and should speak to the health care provider about steps that can be taken.Antiphospholipid syndrome is associated with SLE and can cause pregnancy complications. The nurse should ask the patient whether she has had an antiphospholipid antibody test and inform the patient about antiphospholipid syndrome and potential pregnancy complications.The nurse should ask the patient about pregnancy counseling because counseling will help the patient identify potential complications that may affect pregnancy. Although the nurse can ask the patient whether she has been pregnant before, this question will not help the nurse address potential pregnancy complications. It would be better to ask whether the patient has experienced any complications when trying to conceive.Although the nurse can ask the patient how long she and her partner have been trying to conceive, this question will not help the nurse address potential pregnancy complications.
Which instructions should the nurse include in the teaching plan when educating a patient and his or her caregiver about systemic lupus erythematosus (SLE)? "Avoid excessive exercise in order to conserve your energy." "If you experience an exacerbation, stop taking your medication." "Use sunscreen that has a skin protection factor (SPF) of at least 10." "You need to use powder that keeps your skin dry in order to avoid skin infections."
"Avoid excessive exercise in order to conserve your energy." Patients with SLE should work on methods to conserve energy, and the nurse should provide tips to help the patient with this. The nurse should teach the patient about proper medication use, which involves sticking to a medication regimen. The patient should not stop taking the medication if he or she experiences an exacerbation.Patients with SLE who must be outside during the day should use sunscreen with a minimum SPF of 15, not 10.The nurse should teach patients about using moisturizing lotions to help prevent skin dryness, which is an effect of the disease. Powders will keep the skin dry, further irritate patients' skin, and will not help the patient avoid skin infections.
A patient with systemic lupus erythematosus (SLE) presents with a malar and discoid rash. As the nurse is assessing the patient, which question should the nurse ask? "How many hours of sleep do you get per night?" "Have you spent time outside during the day lately?" "When is the last time you had an exacerbation of SLE?" "Do you take any over-the-counter medications for pain?"
"Have you spent time outside during the day lately?" The nurse should ask the patient if he or she has spent time outside during the day because exposure to ultraviolet light may have caused the rash. It is important to obtain a comprehensive health assessment; however, information about sleeping patterns is not related to the patient's presenting symptoms. The nurse would ask about frequency of exacerbations of SLE, but this is not associated with the patient's presenting symptoms. Asking about pain medications would be relevant if the patient exhibits pain related to arthritis, but this is not related to the patient's presenting symptoms.
The nurse has established a goal of verbalizing an understanding of activities to prevent exacerbations with a female patient with systemic lupus erythematosus (SLE). Which statement made by the patient would support this goal? "I plan to do meditation daily and take time for myself." "I should take the medication when the pain is severe." "I can work in my garden in the afternoon if I pace myself." "My husband and I are planning to conceive a child this year."
"I plan to do meditation daily and take time for myself." The patient's statement that she plans to meditate and set aside time for herself every day indicates that she understands the impact of stress on the disease process. Stating that medication should be taken as soon as the pain becomes severe indicates that the patient understands ways to treat, not to prevent, exacerbations. Exposure to midday sun can precipitate an SLE exacerbation. This statement shows the patient needs further teaching about exacerbation prevention. Hormone levels will be increased during pregnancy, which can precipitate an SLE exacerbation. The patient requires further instruction on methods to prevent exacerbations.
A patient diagnosed with systemic lupus erythematosus (SLE) is taking methotrexate. Which instruction should the nurse provide to the patient? "You need to take a folic acid supplement." "You need to check your blood glucose levels before taking this medication." "Speak to your health care provider about a consultation with an ophthalmologist." "Weigh yourself every week and record the results so you can report them on your next visit."
"You need to take a folic acid supplement." Methotrexate depletes folic acid. Therefore supplementation is required. A patient taking corticosteroids, not methotrexate, would require glucose monitoring because corticosteroids can increase blood glucose levels. Hydroxychloroquine and chloroquine, not methotrexate, can damage a patient's vision. Corticosteroids, such as prednisone, can increase a patient's weight. This side effect does not occur with methotrexate.
A patient with systemic lupus erythematosus (SLE) asks the nurse what happens during an exacerbation of SLE. Which response from the nurse is appropriate? Your body is making antibodies that attack the proteins in your DNA." "There will be increased platelet production that can result in splenomegaly." "Various body organs will be affected, and multiorgan failure may occur." "The mast cells and eosinophils will be activated, thereby facilitating the destruction of pathogens."
"Your body is making antibodies that attack the proteins in your DNA." SLE is an autoimmune disease. An individual with SLE develops antibodies that attack the proteins found in his or her DNA. A patient with SLE will present with a decreased platelet count, or thrombocytopenia, not an increased platelet count. An exacerbation can compromise some organ functions. However, an exacerbation does not lead to multisystem organ failure. The autoimmune response in SLE decreases immune system function. Pathogens are not destroyed, but rather thrive.
The health care provider has prescribed the following interventions for a patient who is taking azathioprine (Imuran) for systemic lupus erythematosus. Which order will the nurse question? Draw anti-DNA blood titer. Administer varicella vaccine. Naproxen (Aleve) 200 mg BID. Famotidine (Pepcid) 20 mg daily.
Administer varicella vaccine. Live virus vaccines, such as varicella, are contraindicated in a patient taking immunosuppressive drugs. The other orders are appropriate for the patient.
A nurse is caring for a patient diagnosed with systemic lupus erythematosus (SLE) who has been on a long-term regimen of methylprednisolone. Which precautions should the nurse take to prevent complications of the treatment? Assess the patient's mental status Check the patient's mouth for sores Monitor the patient's blood glucose levels Ensure the patient receives large amounts of fluids Observe the patient for the development of Raynaud's phenomenon
Assess the patient's mental status Monitor the patient's blood glucose levels The patient is taking methylprednisolone, which can cause psychosis in high doses. Therefore the nurse should carefully monitor the patient's mental status and report any changes, such as confusion, to the health care provider. A patient taking methylprednisolone can have a long-term complication of hyperglycemia, so the nurse should carefully monitor this patient's blood glucose levels. Painless sores in the oral cavity are an expected finding in a patient with SLE. This is not a precautionary assessment the nurse needs to make for a patient with SLE who is taking methylprednisone. Although it is always important for patients to stay properly hydrated, large amounts of fluids are not a specific requirement for a patient with SLE who is taking methylprednisolone.Raynaud's phenomenon can be expected in a patient already diagnosed with SLE. Observing the patient for the development of this manifestation would not prevent complications associated with taking methylprednisolone.
A patient with suspected systemic lupus erythematosus (SLE) asks the nurse which symptoms of the disease are likely to occur. Which manifestations should the nurse include? Select all that apply. Cachexia Hemoptysis Hematemesis Blood in the urine Facial butterfly rash Increased hair growth
Blood in the urine Facial butterfly rash Hematuria is common in patients with SLE because the disease affects the kidneys and allows blood to spill into the urine.A butterfly rash is the most common manifestation of SLE and appears over the nose and cheeks. A patient with SLE may have nausea, vomiting, and diarrhea but will not develop cachexia or wasting syndrome.A patient with SLE may have conditions that indicate lung involvement, such pneumonitis or pleural effusion, but does not usually present with hemoptysis.Hematemesis does not occur in patients with SLE. The patient may have nausea and vomiting but will not have blood in the vomitus. SLE may cause alopecia, or hair loss, but not increased hair growth.
A nurse is caring for a patient with systemic lupus erythematosus (SLE) who reports having mild pain and swelling in the hands. Which medication would the nurse anticipate the health care provider to prescribe? Celecoxb Tacrolimus Chloroquine Azathioprine
Celecoxib Celecoxib is a nonsteroidal antiinflammatory drug that is prescribed to treat arthritic pain related to SLE. Tacrolimus is a topical immunomodulator that is used to treat severe skin irritations related to SLE. It is not used to treat hand pain and swelling. Chloroquine is an antimalarial agent that is used to treat fatigue and joint problems related to SLE. However, it is not as effective for treating mild arthritic pain from SLE and should be reserved for more extreme cases Azathioprine is an immunosuppressant that is prescribed to decrease the autoimmune activity of SLE. It does not work to treat arthritis pain.
The nurse is caring for a newly admitted patient with an exacerbation of systemic lupus erythematosus (SLE). Which interventions should the nurse perform? Select all that apply. Collect frequent urine samples Check patient for signs of hemorrhage Monitor the patient's intake and output Check patient for signs of ulnar deviation Prepare patient for phototherapy to treat skin rashes
Collect frequent urine samples Check patient for signs of hemorrhage Monitor the patient's intake and output The nurse should collect urine samples regularly so the urine can be tested for proteinuria and casts to monitor disease progression.The nurse should monitor the patient for signs of bleeding.The nurse should monitor the patient's intake and output because SLE can cause kidney damage. Although the nurse should assess the patient's signs and symptoms, ulnar deviation would be found in patients with rheumatoid arthritis, not SLE.The patient with SLE has heightened photosensitivity. Although patients with psoriasis, eczema, and other skin conditions may benefit from phototherapy, patients with SLE should not receive phototherapy because of photosensitivity and increased risk of burns.
A patient with systemic lupus erythematosus (SLE) is receiving nonsteroidal anti-inflammatory drug (NSAID) therapy. Which side effect of NSAID therapy should the nurse immediately report to the health care provider? Melena Pancytopenia Hyperglycemia Decreased vision
Melena A patient receiving NSAIDs may have gastrointestinal bleeding. The signs and symptoms of this are dark, almost black stools (melena). If the nurse suspects that blood is present in the stool, he or she should notify the health care provider and expect an order for guaiac testing of the stool. Immunosuppressant therapy, not NSAID therapy, may result in pancytopenia.Corticosteroids, not NSAIDs, may cause hyperglycemia.Antimalarial agents, not NSAIDs, can cause retinopathy.
A female patient comes to the emergency department with a butterfly rash and tests positive for antinuclear antibodies. Which additional tests would the nurse anticipate to be ordered by the health care provider to confirm a diagnosis of systemic lupus erythematosus (SLE)? Urinalysis Pregnancy test C-reactive protein level Serum complement test Determination of the erythrocyte sedimentation rate (ESR)
Urinalysis Serum complement test Urinalysis can confirm whether there is protein or any other indicator of kidney disease in the urine, which is a positive indicator of SLE. A serum complement test will confirm serositis, which is a positive indicator of SLE. Although a pregnancy test should be performed before any medication is given to the patient, a pregnancy test will not confirm a diagnosis of SLE.Although C-reactive protein levels are used in monitoring SLE, a C-reactive protein level does not confirm a diagnosis of SLE.Although ESR can be used to monitor patients with SLE, an elevated ESR does not confirm a diagnosis of SLE.
The nurse is caring for a patient with a new diagnosis of systemic lupus erythematosus (SLE). The patient denies a family history of this disease. Which information in the patient's history identifies a likely cause of the onset of symptoms? History of recent endocarditis Use of a barrier contraceptive Unhealthy food intake at home Use of prescribed procainamide
Use of prescribed procainamide At least 40 prescription medications, including procainamide, can lead to the development of SLE. SLE can result in cardiovascular complications, such as endocarditis, but endocarditis will not cause SLE. Oral, not barrier, contraceptives can trigger the onset or an exacerbation of SLE. Food is usually not a trigger for the onset of SLE.
A 25-yr-old female patient with systemic lupus erythematosus (SLE) who has a facial rash and alopecia tells the nurse, "I never leave my house because I hate the way I look." The nurse will plan interventions with the patient to address the nursing diagnosis of social isolation. activity intolerance. impaired skin integrity. impaired social interaction.
social isolation. The patient's statement about not going anywhere because of hating the way he or she looks expresses social isolation because of embarrassment about the effects of the SLE. Activity intolerance is a possible problem for patients with SLE, but the information about this patient does not support this. The rash with SLE is nonpruritic. There is no evidence of lack of social skills for this patient.
