Final - Lupus (SLE) & Scleroderma (Systemic Sclerosis)
The nurse provides home care instructions to a client with systemic lupus erythematosus and tells the client about methods to manage fatigue. Which statement by the client indicates a need for further instruction? 1."I should take hot baths because they are relaxing." 2."I should sit whenever possible to conserve my energy." 3."I should avoid long periods of rest because it causes joint stiffness." 4."I should do some exercises, such as walking, when I am not fatigued."
1 To help reduce fatigue in the client with systemic lupus erythematosus, the nurse should instruct the client to sit whenever possible, avoid hot baths (because they exacerbate fatigue), schedule moderate low-impact exercises when not fatigued, and maintain a balanced diet. The client is instructed to avoid long periods of rest because it promotes joint stiffness.
The nurse is performing an assessment on a female client who complains of fatigue, weakness, muscle and joint pain, anorexia, and photosensitivity. Systemic lupus erythematosus (SLE) is suspected. What should the nurse further assess for that also is indicative of SLE? 1.Ascites 2.Emboli 3.Facial rash 4.Two hemoglobin S genes
3 Systemic lupus erythematosus is a chronic, progressive, inflammatory connective tissue disorder that can cause major body organs and systems to fail. A butterfly rash on the cheeks and bridge of the nose is an essential sign of SLE. Ascites and emboli are found in many conditions but are not associated with SLE. Two hemoglobin S genes are found in sickle cell anemia.
A client is suspected of having systemic lupus erythematosus (SLE). On reviewing the client's record, the nurse should expect to note documentation of which characteristic sign of SLE? 1. Fever 2.Fatigue 3.Skin lesions 4.Elevated red blood cell count
3 Systemic lupus erythematosus is a chronic, progressive, inflammatory connective tissue disorder that can cause major body organs and systems to fail. The major skin manifestation of SLE is a dry, scaly, raised rash on the face known as the butterfly rash. Fever and fatigue may occur before and during exacerbation, but these signs and symptoms are vague. Anemia is most likely to occur in SLE.
The nurse is reviewing the diagnostic tests prescribed for an assigned client and notes that an "LE cell prep" has been prescribed. Which immune disorder should the nurse primarily anticipate? 1.Histoplasmosis 2.Progressive systemic sclerosis 3.Systemic lupus erythematosus (SLE) 4.Human immunodeficiency virus infection
3 A Lupus erythematosus (LE) cell test is a blood test that measures the presence of a special cell found mostly in individuals with systemic lupus erythematosus. The LE cell prep (lupus erythematosus cell preparation) may be performed in a client suspected of having SLE. It also may be used to screen for progressive systemic sclerosis but is used primarily to screen for SLE. The other options are not associated with this diagnostic test.
The home care nurse provides instructions to a client with systemic lupus erythematosus (SLE) about home care measures. Which statements by the client indicate the need for further instruction? Select all that apply. 1."I need to sit whenever possible." 2."I need to be sure to eat a balanced diet." 3."I need to take a hot bath every evening." 4."I need to rest for long periods of time every day." 5."I should engage in moderate low-impact exercise when I am not tired."
3 4 Systemic lupus erythematosus is a chronic, progressive, inflammatory connective tissue disorder that can cause major body organs and systems to fail. Hot baths may exacerbate the fatigue. To help reduce fatigue in the client with SLE, the nurse should instruct the client to sit whenever possible, avoid hot baths, engage in moderate low-impact exercises when not fatigued, and maintain a balanced diet. The client is instructed not to rest for long periods because it promotes joint stiffness.
A client being seen in an ambulatory clinic for an unrelated complaint has a butterfly rash noted across the nose. The nurse interprets that this finding is consistent with early manifestations of which disorder? 1.Hyperthyroidism 2.Pernicious anemia 3.Cardiopulmonary disorders 4.Systemic lupus erythematosus (SLE)
4 An early sign of SLE is the appearance of a butterfly rash across the nose. Hyperthyroidism often leads to moist skin and increased perspiration. Pernicious anemia is exhibited by pale skin. Severe cardiopulmonary disorders may lead to clubbing of the fingers.
A client seen in an ambulatory clinic has a facial rash that is present on both cheeks and across the bridge of the nose. The nurse interprets that this finding is consistent with manifestations of which disorder? 1.Hyperthyroidism 2.Pernicious anemia 3.Cardiopulmonary disorders 4.Systemic lupus erythematosus (SLE)
4 Systemic lupus erythematosus is a chronic, progressive, inflammatory connective tissue disorder that can cause major body organs and systems to fail. A major skin manifestation of SLE is the appearance of a rash on both cheeks and across the nose. It is known as a "butterfly rash." Hyperthyroidism is associated with moist skin and increased perspiration. Pernicious anemia causes pallor of the skin. Cardiopulmonary disorders may lead to clubbing of the fingers.
A complete blood cell (CBC) count is performed in a client with systemic lupus erythematosus (SLE). The nurse would suspect that which finding will be noted in the client with SLE? 1.Decreased platelets only 2.Increased red blood cell count 3.Increased white blood cell count 4.Decreased number of all cell types
4 Systemic lupus erythematosus is a chronic, progressive, inflammatory connective tissue disorder that can cause major body organs and systems to fail. In the client with SLE, a CBC count commonly shows pancytopenia, a decrease in the number of all cell types. This finding is most likely caused by a direct attack of all blood cells or bone marrow by immune complexes. The other options are incorrect.
A complete blood cell count is performed on a client with systemic lupus erythematosus (SLE). The nurse suspects that which finding will be reported with this blood test? 1.Increased neutrophils 2.Increased red blood cell count 3.Increased white blood cell count 4.Decreased numbers of all cell types
4 Systemic lupus erythematosus is a chronic, progressive, inflammatory connective tissue disorder that can cause major body organs and systems to fail. In the client with SLE, a complete blood cell count commonly shows pancytopenia, a decrease in all cell types. This probably is caused by a direct attack on all blood cells or bone marrow by immune complexes. The other options are incorrect.
The nurse is caring for a client admitted with a diagnosis of systemic lupus erythematosus (SLE). A highly sensitive C-reactive protein (hsCRP) blood test is prescribed. What other blood test is often used along with the hsCRP? 1.Cardiac enzymes 2.Serum electrolytes 3.Complete blood count (CBC) 4.Erythrocyte sedimentation rate (ESR)
4 The hsCRP is a test to measure inflammation in clients with an autoimmune disease such as SLE and is often done with or instead of the ESR. Both tests are very useful for detecting inflammation anywhere in the body. Cardiac enzymes, serum electrolytes, and a CBC are incorrect.
A young adult patient with systemic lupus erythematosus (SLE) tells the nurse "I want to have a baby" and is "considering getting pregnant." Which response by the nurse is most appropriate? a. "Infertility can result from some medications used to control your disease." b. "Temporary remission of your signs and symptoms is common during pregnancy." c. "Autoantibodies transferred to the baby during pregnancy will cause heart defects." d. "The baby is at high risk for neonatal lupus erythematosus being diagnosed at birth."
A Infertility may be caused by renal involvement and the previous use of high-dose corticosteroid and chemotherapy drugs. Neonatal lupus erythematosus rarely occurs in infants born to women with SLE. Exacerbation is common after pregnancy during the postpartum period. Spontaneous abortion, stillbirth, and intrauterine growth retardation are common problems with pregnancy related to deposits of immune complexes in the placenta and because of inflammatory responses in the placental blood vessels. There is not an increased risk for heart defects.
A patient is prescribed Belimumab for treatment of lupus. The patient has been taking the medication for one month. Which finding below during a patient assessment requires further evaluation? A. The patient reports trouble sleeping and loss of energy. B. The patient declines a flu shot via the intranasal route. C. The patient says they have not noticed a change in symptoms. D. The patient administers the medication in the subcutaneous tissue on the abdomen.
A The answer is A. Belimumab is a Biologic that binds with a protein that supports the activity of B-cells to decrease the activity of B-cells, which decreases antibody attacks and decreases inflammation. Depression and suicide are serious side effects of this medication. Option A demonstrates the patient may be experiencing depression and further evaluation is needed. Option B is correct because the patient should avoid LIVE vaccines like the flu vaccine via the intranasal route, Option C is correct because this medication can take up to 6 months to start working, and Option D is correct because this medication can be given via injection (subq fat of the upper legs or abdomen) or infusion.
A patient with Systemic Lupus Erythematous (SLE) takes the medication Azathioprine. Which statement by the patient requires re-education? A. "I've made sure all my vaccines are up-to-date, and I'm getting the Shingles vaccine next week." B. "This medication can increase my chances for developing infection." C. "This medication is "steroid-sparing" meaning it may help lower the amount of steroids I may need to manage my lupus." D. "This medication lowers my immune system."
A The answer is A. Azathioprine is an immunosuppressant. Patients can have vaccines while taking this medication but NOT live vaccines...like shingles, MMR etc.
Which statements below are INCORRECT about Systemic Lupus Erythematosus? Select all that apply: A. Lupus mainly affects Black, Asian, and Hispanic men. B. Lupus is a chronic condition that has periods of flare-ups and remission. C. The joints and skin are rarely affected in lupus. D. Systemic Lupus Erythematosus (SLE) is the most common form of lupus.
A C The answers are A and C. Options B and D are correct statements about lupus. Option A is wrong because lupus mainly affects Black, Asian, and Hispanic WOMEN (not men). Option C is wrong because lupus DOES affect the joints and skin along with many other systems of the body (heart, lungs, kidneys, blood system, brain etc.).
In teaching a pt w/ systemic lupus erythematosus about the disorder, the nurse knows the pathophysiology includes: a. circulating immune complexes formed from IgG autoantibodies reaching with IgG. b. an autoimmune T-cell reaction that results in destructions 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.
D SLE is marked by production of many autoantibodies against nucleic acids (e.g., single-and double-stranded DNA), erythrocytes, coagulation proteins, lymphocytes, platelets, and many other self-proteins. Autoimmune reactions (antinuclear antibodies [ANA]) are typically directed against constituents of the cell nucleus, especially DNA.
A nurse is assessing a client who has a new diagnosis of SLE. Which of the following findings should the nurse expect? A. Weight gain B. Petechiae on thighs C. Systolic murmur D. Alopecia
D Alopecia (hair loss) is an expected finding in a client who has SLE.
Which statements are true about the pathogenesis of Systemic Lupus Erythematosus? Select all that apply: A. The phagocytosis process is not occurring properly, which causes the nuclear material inside the dying cell to be seen as a foreign invader and antinuclear antibodies are created. B. During cell death the nucleus of the cell fails to condense, which leads to the development of autoantibodies. C. Immune complexes form and attach within the structures of important organs, joints, and tissues, and this causes inflammation. D. Neutrophil activity is decreased and this causes B-cells to attack phagocytes and nuclear material within the cells, which leads to the activation of the complement cascade system and inflammation.
A C The answers are A and C. These are correct statements about the pathogenesis of SLE. In a nutshell, apoptosis is ineffective (specifically how the macrophages/phagocytes consume the fragmented parts of the dying cell during apoptosis). These fragmented parts of the dying cell are not consumed (either the consumption by the macrophages is too slow or they are not consumed), and the nuclear material inside the small bodies spill into the extracellular space. The immune system recognizes this as an antigen "antinuclear antigens" and forms antinuclear antibodies to attack them. The antibodies attack the antigens and form immune complexes. These immune complexes now start to "float" around in the body and get stuck in various organs, joints, and tissues. This leads to the activation of the complement system and causes inflammation. This inflammation damages the structure (hence the organs/tissues/joint)s.
A nurse is reviewing the plan of care for a client who has systemic lupus erythematosus (SLE). The client reports fatigue, joint tenderness, swelling, and difficulty urinating. Which of the following laboratory findings should the nurse anticipate? (Select all that apply.) A. Positive ANA titer B. Increased hemoglobin C. 2+ urine protein D. Increased serum C3 and C4 E. Elevated BUN
A C E : A positive antinuclear antibody (ANA) titer is an expected finding in a client who has SLE. The ANA test identifies the presence of antibodies produced against the client's own DNA. Increased urine protein is an expected finding due to kidney injury as a result of SLE. Elevated BUN is an expected finding due to kidney injury in a client who has SLE.
A patient with systemic lupus erythematosus has been prescribed 2 weeks of high-dose prednisone therapy. Which information about the prednisone is most important for the nurse to include? a. ―Weigh yourself daily to monitor for weight gain. b. ―The prednisone dose should be decreased gradually. c. ―A weight-bearing exercise program will help minimize risk for osteoporosis. d. ―Call the health care provider if you have mood changes with the prednisone.
ANS: B Acute adrenal insufficiency may occur if exogenous corticosteroids are suddenly stopped. Mood alterations and weight gain are possible adverse effects of corticosteroid use, but these are not life-threatening effects. Osteoporosis occurs when patients take corticosteroids for longer periods.
The nurse would determine additional instruction is needed when a patient diagnosed with scleroderma makes which statement? a. ―Paraffin baths can be used to help my hands. b. ―I should lie down for an hour after each meal. c. ―Lotions will help if I rub them in for a long time. d. ―I should perform range-of-motion exercises daily.‖
ANS: B Because of the esophageal scarring and to reduce heartburn with reflux, patients should sit up for 2 hours after eating rather than lying down. Paraffin baths, lotions, and range of motion are helpful in managing the symptoms and would indicate good understanding of the teaching.
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
ANS: B 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 has scleroderma manifested by CREST (calcinosis, Raynaud's phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia) syndrome. Which action would the nurse include in the plan of care? a. Avoid use of capsaicin cream on hands. b. Keep the environment warm and draft free. c. Obtain capillary blood glucose before meals. d. Assist to bathroom every 2 hours while awake.
ANS: B Keeping the room warm will decrease the incidence of Raynaud's phenomenon, one aspect of the CREST syndrome. Capsaicin cream may be used to improve circulation and decrease pain. There is no need to obtain blood glucose or to assist the patient to the bathroom every 2 hours.
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.
ANS: B Live virus vaccines, such as varicella, are contraindicated in a patient taking immunosuppressive drugs. The other orders are appropriate for the patient.
Which action for the care of a patient who has scleroderma can the registered nurse (RN) delegate to assistive personnel (AP)? a. Monitor for difficulty in breathing. b. Document the patient's oral intake. c. Check finger strength and movement. d. Apply capsaicin (Zostrix) cream to hands.
ANS: B Monitoring and documenting patient's oral intake is included in AP education and scope of practice. Assessments for changes in physical status and administration of medications require more education and scope of practice and should be done by RNs.
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.
ANS: B 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.
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
ANS: B 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.
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
ANS: C 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 information about plasmapheresis would the nurse include in the teaching plan for a patient diagnosed with systemic lupus erythematosus (SLE)? a. Plasmapheresis counteracts recovery of IgG production. b. Plasmapheresis removes eosinophils and basophils from the blood. c. Plasmapheresis decreases the damage to organs from T lymphocytes. d. Plasmapheresis prevents inflammatory mediators from injuring tissues.
ANS: D Plasmapheresis is used in SLE to remove antibodies, antibody-antigen complexes, and inflammatory mediators, such as complement, from the blood. T lymphocytes, foreign antibodies, eosinophils, and basophils do not directly contribute to the tissue damage in SLE. Immunosuppressive therapy is used to prevent recovery of IgG production.
A nurse is caring for a client who has SLE and is experiencing an episode of Raynaud's phenomenon. Which of the following findings should the nurse anticipate? A. Swelling of joints of the fingers B. Pallor of toes with cold exposure C. Feet that become reddened with ambulation D. Client report of intense feeling of heat in the fingers
B Pallor of the extremities occurs in Raynaud's phenomenon in a client who has SLE and has been exposed to cold or stress.
Which medication below used to treat Systemic Lupus Erythematosus decreases inflammation quickly, is not for long-term usage, and can lead to weight gain, susceptibility to infection, diabetes, and osteoporosis? A. Hydroxychloroquine B. Prednisone C. Azathioprine D. Belimumab
B The answer is B. The question above is describing steroids. Prednisone is a steroid medication. These are medications used to treat lupus. They decrease inflammation quickly, are not for long-term usage, and can lead to weight gain, susceptibility to infection, diabetes, and osteoporosis.
A patient is diagnosed with Systemic Lupus Erythematous (SLE). You note the patient has a red rash that starts on the nose and expands onto the cheeks of the face. This is known as what type of rash? A. Discoid B. Malar C. Miliaria D. Eczema
B The answer is B: Malar (it's also called a butterfly rash).
A patient with Systemic Lupus Erythematosus is experiencing a complication called Lupus Nephritis. What are some signs and symptoms that correlate with this complication of SLE? Select all that apply: A. Decreased Creatinine B. Increased BUN C. 48 hour urinary output of 720 mL D. Proteinuria E. Weight loss F. Edema in upper and lower extremities
B C D F The answers are B, C D, and F. Lupus nephritis is a serious complication of SLE. It is a condition that affects the functional units of the kidneys called the nephrons. In severe cases, renal failure develops which leads to an INCREASED BUN/Creatinine, low UOP (<30 mL/hr), proteinuria, weightGAIN, and swelling in the upper and lower extremities.
A patient is undergoing testing for the evaluation of Systemic Lupus Erythematous. What lab findings below are associated with this condition? Select all that apply: A. Decreased ESR and CRP B. Positive ANA C. Positive Anti-dsDNA D. Negative Anti-Sm E. Low C3 and C4
B C E The answers are B, C, and E. A positive ANA (anti-nuclear antibodies) demonstrates there are autoantibodies the body created against the nuclei of the dying cells (almost all patient with lupus will have a positive ANA), but these anti-nuclear antibodies can also be present with other autoimmune disorders. A positive anti-dsDNA (anti-double stranded DNA anti-body) is a particular anti-nuclear antibody found in some patients with lupus and is not typically present in patients who don't have lupus. An INCREASE in ESR and CRP would be found in a patient with lupus (especially during a flare) along with a POSITIVE Anti-Sm antibody (which is a particular antibody found in the nucleus that is present in lupus).
A patient with Systemic Lupus Erythematosus is prescribed Hydroxychloroquine. Select all the educational points you will include in the patient's education about this medication: A. Hydroxychloroquine is considered a Biologic medication. B. It is used long-term to help prevent flares. C. This medication doesn't produce results immediately. Therefore, the patient may not see results for a couple of months. D. This medication binds with a protein that supports the activity of B-cells, which decreases the activity of B-cells. E. The patient must have their eyes checked regularly to monitor the retina while taking this medication.
B C E The answers are B, C, and E. Hydroxychloroquine is an antimalarial medication. It decreases antibodies attacking the body (option D describes a biologic like Belimumab). If used long-term it can damage the retinas of the eyes (the patient needs a minimum of 1 eye exam per year while taking this med). It also takes a couple of months to start working.
During the death process of a cell, which immune system cell is responsible for ingesting the fragments of the dying cell? A. T-cells B. B-cells C. Macrophages D. Neutrophils
C Macrophages (also known as phagocytes) digest the tiny fragments of the dying cell called apoptotic bodies. In lupus, this process is either occurring too slowly or not performed correctly (but either way the immune system sees the nuclear material from these bodies as foreign "antinuclear antigens" and forms autoantibodies against them and this causes immune complexes to form...and inflammation of body systems).
The nurse is delivering teaching to a patient newly diagnosed with 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 have a high chance of getting arthritis." c. "I'm hoping surgery will be an option for me in the future." d. "I understand I'm going to be vulnerable to getting infections."
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.
You're providing education to a Systemic Lupus Erythematosus support group about preventing flares. Which statement by a participant requires re-education about this topic? A. "Emotional stress and illness are triggers for a flare-up." B."I always wear large-brimmed hats and long sleeves when I'm outside." C. "Exercise should be avoided due to the physical stress it causes on the body." D. "I will make it priority to receive my yearly influenza vaccine.
C The answer is C. Exercise is a very important step in preventing lupus flares. It helps maintain joint stability and manages weight. Exercise should not be limited but encouraged to as much as the patient can tolerate. Remember LESS for less flares: Lower stress (avoid overworking, emotional, illness, and use techniques to have prevent stress), Exercise (helps joints and manages weight), Sleep (need more than 8 hours to prevent the body from getting too exhausted), Sun Protection (sunscreen and large-brimmed hats...sunlight can activate a flare).
A 26-year-old female with Systemic Lupus Erythematosus has been hospitalized with a flare-up. The patient is now recovered and is about to be discharged. The patient expresses that she wants to have a baby soon. How long should the woman be advised to be in remission of this condition before trying to conceive a baby? A. 2 months B. 2 years C. 6 months D. 1 year
C The answer is C. Women with lupus, who want to become pregnant, need to make sure their lupus has been in control (hence remission....no flare-ups) for at least 6 months before conceiving. This is because there is a risk of miscarriage and clotting issues. Pregnancy and the post-partum period can cause flares.
A nurse is teaching a client who has SLE about self‑care. Which of the following statements by the client indicates an understanding of the teaching? A. "I should limit my time to 10 minutes in the tanning bed." B. "I will apply powder to any skin rash." C. "I should use a mild hair shampoo." D. "I will inspect my skin once a month for rashes."
C A client who has SLE should use a mild hair shampoo that does not irritate the scalp.
