Lupus NCLEX Practice Questions

The laboratory results of a client with systemic lupus erythematosus​ (SLE) indicates anemia. Which collaborative therapy should the nurse​ anticipate? A. Performing a splenectomy B. Treating the underlying cause C. Administering corticosteroids D. Administering erythropoietin

D. Administering erythropoietin For the client with​ anemia, medications such as erythropoietin may be given to stimulate red blood cell production. A splenectomy and the administration of corticosteroids are clinical therapies to treat thrombocytopenia. The underlying cause of the anemia is SLE. The disease cannot be​ cured, but the symptoms can be managed.

In a community​ setting, the nurse is providing care to a client who was recently diagnosed with systemic lupus erythematosus​ (SLE). Which is the goal of care for this​ client? (Select all that​ apply.) A. Reducing pain B. Preventing infections C. Maintaining skin integrity D. Reducing inflammation E. Limiting fluid intake

A. Reducing pain B. Preventing infections C. Maintaining skin integrity D. Reducing inflammation The treatment goals for clients with SLE are to reduce​ pain, reduce​ inflammation, prevent​ infections, maintain skin​ integrity, prevent​ exacerbations, and improve coping skills. Fluid and nutrition should be balanced while taking kidney function into consideration.

The nurse is assessing a client with systemic lupus erythematosus​ (SLE). Which clinical manifestation should the nurse expect to​ observe? (Select all that​ apply.) A. Red butterfly rash on the face B. Alopecia C. Psoriatic lesions D. Painful or swollen joints E. Leg and eye edema

A. Red butterfly rash on the face B. Alopecia D. Painful or swollen joints E. Leg and eye edema ​Rationale: Painful swollen​ joints, alopecia, red butterfly rash on the​ face, and leg and eye edema are all characteristics of SLE. Psoriatic lesions are caused by​ psoriasis, which is an autoimmune disease characterized by patches of abnormal skin.

A client diagnosed with systemic lupus erythematosus​ (SLE) is experiencing pulmonary interstitial fibrosis. Which classification of lupus should the nurse​ suspect? A. Systemic ​B. Drug-induced C. Discoid D. Cutaneous

A. Systemic The classification of lupus the client is experiencing is systemic. There are three major classifications of​ SLE: discoid or​ cutaneous, systemic, and​ drug-induced. Systemic lupus involves one or more of these​ systems: cardiovascular, central​ nervous, hematologic,​ kidneys, lungs, and musculoskeletal. Cutaneous or discoid lupus is limited to the skin. Many drugs can cause a syndrome that mimics lupus​ (drug-induced lupus).

The nurse is admitting a client with systemic lupus erythematosus​ (SLE) for an upper respiratory infection. Which nursing goal is the priority​? A. The client demonstrates proper hand hygiene. B. The client can verbalize the impact of the diagnosis to the healthcare provider. C. The client can verbalize the importance of oral care. D. The client can verbalize skin care needs to reduce the risk of altered skin integrity.

A. The client demonstrates proper hand hygiene. The client demonstrating proper hand hygiene will reduce the risk of infection. Alterations in skin​ integrity, including those in the oral​ cavity, can increase the risk of acute exacerbation of SLE. It is important for the client diagnosed with SLE to be able to verbalize the impact of the disease to the healthcare provider in order to address the​ client's psychosocial​ well-being. Next Question

The nurse is caring for a client who is hospitalized due to an exacerbation of systemic lupus erythematosus (SLE). The nurse is reviewing the client's lab work and finds the white blood cell count (WBC) is shifted to the left. Based on this information, which is a priority nursing diagnosis for this client? A) Ineffective Protection B) Ineffective Health Maintenance C) Ineffective Individual Coping D) Risk for Impaired Skin Integrity

Answer: A Explanation: A) All identified diagnoses are appropriate for a client with SLE. However, the shift to the left in the WBC count indicates an increased risk for infection. A shift to the left in a WBC differential is indicative of a large number of immature cells, suggesting infection, and is therefore the priority for the client with the diagnosis Ineffective Protection.

A nurse caring for a client with SLE on immunosuppressive therapy understands that careful teaching is required to make sure both clients and family members understand appropriate precautions against the threat of infection. Teaching points should include: Select all that apply. A) Avoid large crowds and situations that increase exposure to infection. B) Report difficulty breathing or cough to the physician if taking cyclophosphamide. C) Use ibuprofen instead of acetaminophen if fever develops. D) Women may develop heavy menstrual bleeding during therapy.

Answer: A, B Explanation: A) The nurse should teach the client and family regarding avoiding large crowds and situations that increase exposure to infection and to report difficulty breathing or cough. The client should report a fever if it develops, and ibuprofen should not be used, as this may increase the risk for bleeding. Women may have an absence of menstruation, not heavy bleeding, during therapy.

A client with SLE is being treated with immunosuppressant drugs and corticosteroids. Which precautions should the nurse provide this client? Select all that apply. A) Avoid large crowds. B) Don't get a flu shot. C) Use contraception to prevent pregnancy D) Refrain from taking aspirin or ibuprofen. E) Report signs of infection to the physician.

Answer: A, C, D, E Explanation: A) Crowds may increase exposure to infection. Annual influenza vaccination is recommended but clients with significant immunosuppression should not receive live vaccines. Immunosuppressive drugs may increase the risk of birth defects. Aspirin or ibuprofen may increase the risk of bleeding. Chills, fever, sore throat, fatigue, or malaise should be reported.

The nurse is providing health education to a diverse group at a neighborhood community center. Why does the nurse plan to include signs and symptoms of systemic lupus erythematosus (SLE)? A) The neighborhood is composed of many young female children. B) The audience has asked the nurse to include the information. C) The audience is mainly composed of Caucasian women. D) The audience is mainly females of Asian-American descent.

Answer: D Explanation: A) Among women who are of child-bearing age, SLE is seen in more African-Americans, Hispanics, and Asian-Americans than Caucasians. There is no evidence that the audience asked for the information.

The nurse is planning care for an adolescent client who has systemic lupus erythematosus (SLE). The nurse knows that the treatment plan implemented by the healthcare team is appropriate for the situation when the client: A) Refuses to attend school. B) Does not want to attend any social functions. C) Discusses skin changes with the healthcare personnel. D) Discusses skin changes with a good friend.

Answer: D Explanation: A) Peer interaction is important to teens. Being able to discuss the physical changes related to SLE with a friend indicates acceptance of the change in body image. Refusing to go to school or attend social functions indicates nonacceptance of the changes to body image. Discussing changes only with healthcare personnel does not indicate the teen has adjusted to the body image changes.

Which laboratory test is used in the diagnosis of systemic lupus erythematosus​ (SLE)? (Select all that​ apply.) A. Triglyceride levels B. Erythrocyte sedimentation rate​ (ESR) C. Urinalysis D. Complete blood count​ (CBC) E. ​Anti-DNA antibody testing

B. Erythrocyte sedimentation rate​ (ESR) C. Urinalysis D. Complete blood count​ (CBC) E. ​Anti-DNA antibody testing The laboratory tests that are used in the diagnosis of SLE are​ anti-DNA antibody testing to detect antibodies that occur in​ SLE, erythrocyte sedimentation rate​ (ESR) to detect elevation related to​ SLE, serum complement levels to detect depletion by​ antigen-antibody complexes of​ SLE, complete blood count​ (CBC) to detect anemia and overall​ pancytopenia, and urinalysis for abnormal traces of blood and protein indicating kidney dysfunction related to SLE. Triglycerides are measured in the diagnosis of cardiovascular diseases like atherosclerosis.

A client with a history of systemic lupus erythematosus​ (SLE) anxiously​ states, "My chest hurts when I lie down. I think it is from coughing so much. Please sit me​ up." Which condition should the nurse first​ suspect? A. Anemia B. Myocardial infarction C. Pericarditis D. Thrombocytopenia

C. Pericarditis A client diagnosed with SLE is at risk for pericarditis. Clinical manifestations of pericarditis include chest pain radiating to the​ back, relieved by sitting forward and worsening when lying​ down, and a dry cough. Electrocardiogram​ (ECG) findings in pericarditis are an ST elevation and PR depression. Although clients with SLE are prone to thrombocytopenia and​ anemia, the clinical presentation is not consistent with these conditions. While a myocardial infarction should be​ considered, the symptoms combined with the​ client's history should first lead the nurse to suspect pericarditis.

A client diagnosed with systemic lupus erythematosus​ (SLE) presents with​ fatigue, joint​ pain, oral​ ulcers, and a red rash over the face and upper trunk. Which collaborative therapy should the nurse expect to​ implement? A. Surgical drainage of affected joints B. Antibiotic therapy C. Physical therapy to improve mobility D. Corticosteroid therapy

D. Corticosteroid therapy The nurse would expect corticosteroid therapy to be ordered. SLE is an autoimmune​ disorder, and corticosteroids and rest are the​ first-line treatment. It is a disorder of the​ muscles, so the nurse would not expect surgical drainage of the joints. It is​ autoimmune, not​ infective, in​ origin, so the nurse would not expect antibiotic therapy as a​ first-line treatment unless the client also has signs of infection.​ Also, a priority treatment is​ rest, so the nurse would not expect physical therapy to be ordered to improve mobility.

The nurse is caring for a client with systemic lupus erythematosus​ (SLE). Which system should the nurse consider as being most affected by the formation of immune complexes and tissue​ damage? A. Cardiac B. Integumentary C. Respiratory D. Renal

D. Renal When the SLE autoantibodies react with their corresponding​ antigen, they form immune​ complexes, which are then deposited in the connective tissue of blood​ vessels, lymphatic​ vessels, and other tissues. These deposits trigger an inflammatory response that leads to local tissue damage. The kidneys are a frequent site of complex deposition and damage. The other systems include​ cardiac, respiratory, and integumentary.

The nurse is teaching a new colleague the effects of drugs used for clients with systemic lupus erythematosus​ (SLE). Which statement by the colleague indicates the need for further​ teaching? ​A. ​"When the client is on aspirin​ therapy, I should monitor for renal​ toxicity." B. ​"Corticosteroid therapy can cause cushingoid​ effects." C. ​"If a cytotoxic agent is​ prescribed, infection may​ occur." D. ​"Thrombosis prevention is a positive side effect with aspirin​ therapy."

A. ​"When the client is on aspirin​ therapy, I should monitor for renal​ toxicity." Aspirin therapy may cause liver toxicity and​ hepatitis, not renal toxicity. Corticosteroid therapy can cause cushingoid effects. Aspirin is particularly beneficial for clients with SLE because its antiplatelet effects help to prevent thrombosis. Cytotoxic drugs can cause​ immunosuppression, placing the client at risk for​ infection, malignancy, and bone marrow depression.

The client enters the outpatient clinic and states to the triage nurse, "I think I have the flu. I'm so tired, I have no appetite, and everything hurts." The triage nurse assesses the client and finds a butterfly rash over the bridge of nose and on the cheeks. Which diagnosis does the nurse expect? A) Systemic lupus erythematosus B) Fibromyalgia C) Lyme disease D) Gout

Answer: A Explanation: A) The rash over the nose and cheeks is sometimes called a butterfly rash and is classic for the diagnosis of systemic lupus erythematosus (SLE), although not every client diagnosed with this disorder will have this rash. While fibromyalgia, Lyme's disease, and gout share some symptoms of SLE, they do not cause a rash over the nose and cheeks.

The nurse is providing care for a newly married woman with systemic lupus erythematosus (SLE). Which client statement indicates plan of care understanding? A) "I will take birth control pills while I am taking cytotoxic medications." B) "I do not need to contact the doctor if I develop a fever or rash." C) "I plan to go to the movies this weekend so that I get out of the house." D) "I can take ibuprofen as indicated for pain."

Answer: A Explanation: A) Treatment for SLE can include cytotoxic drugs. The client is taught to avoid pregnancy by using contraceptives, as these drugs can cause birth defects. The client is taught to avoid crowds, as they are potential sources of infection. Client with SLE should contact their primary care providers should signs of infection occur, as the immune system is compromised. Aspirin and ibuprofen can cause bleeding and should be taken with extreme care.

A nurse is caring for a client with systemic lupus erythematosus (SLE). The client begins to cry and tells the nurse that she is afraid that her skin will be disfigured with lesions. Which intervention does the nurse plan to teach this client to minimize skin infections associated with SLE? Select all that apply. A) Use sunscreen with an SPF of 15 or greater. B) Remain indoors on sunny days. C) Avoid swimming in a pool or the ocean. D) Avoid sun exposure between 10:00 a.m. and 3:00 p.m. E) Decrease sun exposure between 3:00 p.m. and 5:00 p.m.

Answer: A, D Explanation: A) The nurse teaches the client to live a normal life with a few extra precautions. There is a relationship between sun exposure and infection, so the client is taught to use sunscreen with an SPF of at least 15 and to avoid the sun between 10:00 a.m. and 3:00 p.m. The client may swim but should reapply sunscreen after swimming. The client does not need to stay indoors on sunny days or to decrease sun exposure between 3:00 p.m. and 5:00 p.m.

The nurse is caring for a client who has been diagnosed with discoid lupus erythematosus. The nurse is collaborating with the client to set goals for the nursing plan of care. What is an appropriate goal for this client? A) Work through the stages of death and dying. B) Comply 100% of the time with a sun protection plan. C) Gain weight to within 10 pounds of normal for height. D) Report pain no higher than four on a scale of 1-10.

Answer: B Explanation: A) Discoid lupus erythematosus is an autoimmune disorder of the skin, so the client must protect against the sun to avoid skin cancers and other complications. It is not fatal, is not related to weight, and is rarely painful unless complications arise.

A nurse is caring for a client with systemic lupus erythematous (SLE) who is taking hydroxychloroquine (Plaquenil). The nurse understands that the primary concern with this drug is: A) Pulmonary fibrosis. B) Cushingoid effects. C) Retinal toxicity. D) Renal toxicity.

Answer: C Explanation: A) Hydroxychloroquine (Plaquenil) is an antimalarial drug used in SLE to reduce the frequency of acute episodes of SLE. The primary concern with Plaquenil is retinal toxicity and possible irreversible blindness. Cushingoid effects are a concern with corticosteroid therapy. Pulmonary fibrosis is a potential adverse effect of cyclophosphamide, not Plaquenil. Renal toxicity is not the primary concern with Plaquenil.

A female client asks the nurse if there are any conditions that can exacerbate systemic lupus erythematosus (SLE). Which is the best nurse response? A) "Conditions that cause hypotension can often exacerbate SLE." B) "GI upset is often associated with SLE exacerbation." C) "Pregnancy is often associated with an SLE exacerbation." D) "Fever is a known trigger for an SLE exacerbation."

Answer: C Explanation: A) Pregnancy can be associated with an exacerbation of SLE due to the rise of estrogen levels. Hypotension, fever, and GI upset are not factors that risk exacerbation of SLE.

The nurse is teaching a client newly diagnosed with systemic lupus erythematosus​ (SLE). Which information should the nurse include in the​ client's teaching? A. Using​ high-dose birth control pills B. Avoiding large crowds C. Using only acetaminophen for pain relief D. Increasing daily sun exposure

B. Avoiding large crowds The client should be advised to avoid large crowds to decrease exposure to infection. Instruct the client to limit sun exposure and to use sunscreen with an SPF rating of 15 or higher when outdoors. The client should take aspirin or ibuprofen for​ pain, but should monitor for side effects of bleeding. The client should be encouraged to use contraception to prevent​ pregnancy, because the prescribed drugs for treatment may increase the risk for birth defects

The nurse is caring for a pregnant client with systemic lupus erythematosus​ (SLE). Which neonatal complication related to maternal lupus should the nurse anticipate the fetus to be tested for during the second trimester of​ pregnancy? A. Liver involvement B. Congenital heart block​ (CHB) C. Anemia D. Renal anomalies

B. Congenital heart block (CHB) Congenital heart block​ (CHB) may occur in the fetus of a mother diagnosed with SLE. Fetal echocardiography may be used to assess for CHB in the second trimester of pregnancy. The prognosis for CHB​ varies, depending on when the congenital heart defect is detected. With​ treatment, early CHB may be reversible.​ However, late CHB could require the insertion of a pacemaker at the time of delivery. Fetal​ anemia, renal​ anomalies, and liver involvement are not tested for in the second trimester of pregnancy.

The nurse is caring for a client with systemic lupus erythematosus​ (SLE) who presents with pain and discomfort. Which treatment option should the nurse​ anticipate? (Select all that​ apply.) A. Proper nutrition B. Corticosteroids C. NSAIDs D. Increasing sun exposure E. Moderate exercise

B. Corticosteroids E. Moderate exercise C. NSAIDs NSAIDs are used to treat inflammation and pain in clients with SLE. A prescribed exercise plan can alleviate pain but must be balanced with adequate rest.​ Low-dose corticosteroids are used to reduce pain and inflammation in SLE. Improving nutrition promotes a​ well-balanced diet, improving overall health in​ clients, but does not specifically impact pain. Some medications that are used to treat SLE cause sun​ sensitivity; therefore, clients are advised to decrease the amount of time in the sun and to use sunscreen and other forms of sun protection when outdoors.

The nurse is assessing a client with systemic lupus erythematosus​ (SLE). Which manifestation should the nurse recognize as a result of​ inflammation? (Select all that​ apply.) A. Cough B. Malaise C. Maculopapular rash D. Joint pain E.Fever

B. Malaise C. Maculopapular rash D. Joint pain E. Fever In​ SLE, the immunocomplexes that are deposited in the connective tissue trigger an inflammatory response. Joint​ pain, fever,​ malaise, and maculopapular rash are all signs of the inflammation that result from local tissue damage. A cough is a sign of​ infection, not of inflammation resulting from tissue damage.

The nurse is preparing a presentation on systemic lupus erythematosus​ (SLE). Which statement should the nurse​ include? (Select all that​ apply.) A. The etiology is known to be linked to environmental factors. B. Manifestations can be mild to​ fatal, with remissions and exacerbations. C. The immune complex deposits trigger an inflammatory response. D. SLE is a result of deposition of antigen-antibody complexes in connective tissues. E. The inflammatory response leads to anaphylactic shock.

B. Manifestations can be mild to​ fatal, with remissions and exacerbations. C. The immune complex deposits trigger an inflammatory response. D. SLE is a result of deposition of antigen-antibody complexes in connective tissues. The pathophysiology of systemic lupus erythematosus is a result of the formation of antigen-antibody immunocomplexes that are deposited in the connective tissue and trigger an inflammatory response. The manifestations of the disease can be mild to​ fatal, and remissions are followed by exacerbations. The inflammatory response leads to tissue damage but not anaphylactic shock​ (allergic reaction). Although the exact etiology of SLE is​ unknown, genetic,​ ethnic, environmental, and hormonal factors play a role in its development.

The nurse is reviewing medications ordered for a newly admitted female client with systemic lupus erythematosus​ (SLE). Which medication order should the nurse​ question? A. Corticosteroid B. Oral contraceptive C. Immunosuppressive D. Antineoplastic

B. Oral contraceptive High-dose​ corticosteroids, immunosuppressants, and antineoplastic drugs are all used for the treatment of acute SLE. Caution needs to be taken with the use of oral contraceptives because estrogen triggers the symptoms of SLE.

The nurse is planning care for an adolescent client with systemic lupus erythematosus​ (SLE). Which nursing diagnosis is a special consideration for this​ client? A. Fluid​ Volume: Imbalanced, Risk for B. ​Infection, Risk for C. ​Memory, Impaired D. Body​ Image, Disturbed

D. Body​ Image, Disturbed The adolescent client with SLE needs special consideration for body image​ disturbance, such as hair loss and moon​ face, resulting from the effects of medication for treatment of SLE. A risk for infection and increased risk of fluid volume imbalance apply to all clients with SLE. Impaired memory is not a typical clinical manifestation of SLE.​ (NANDA-I ©2014)

An older adult client is experiencing an acute episode of systemic lupus erythematosus​ (SLE). Which primary concern should the nurse consider when administering newly prescribed​ medications? A. Neurological function B. Cardiovascular function C. Respiratory function D. Renal function

D. Renal function Treatment for the older adult client is the same regardless of the age at onset of the disease. In addition to taking into consideration that older adults may be taking multiple​ medications, these individuals may have decreased renal function. Pharmacokinetics and​ drug-to-drug interactions need to be considered prior to the initiation of medications commonly used to treat SLE.​ Respiratory, neurological, and cardiovascular function are​ important, but the renal system remains a primary concern.

The nurse is providing teaching for a client diagnosed with systemic lupus erythematosus​ (SLE) experiencing alterations in skin integrity. Which client statement indicates effective​ teaching? A. ​"I will use fluorescent​ lighting." B. ​"I will apply sunscreen immediately prior to going​ outdoors." C. ​"I will limit the use of​ cosmetics." D. ​"I will cover the lesions on my head with a​ wig."

​C. "I will limit the use of​ cosmetics." Cosmetics can irritate the skin and increase the risk of integumentary symptoms. It is important for the​ client's safety to use adequate lighting to prevent​ injury, and to specifically avoid fluorescent lighting. Fluorescent lighting has been linked to exacerbation of SLE. If the client experiences​ alopecia, it is important that a wig is avoided when skin integrity is impaired. The client should apply sunscreen 30 minutes prior to going out in the sun.

The nurse is caring for a client with exacerbation of systemic lupus erythematosus​ (SLE). Which statement by the nurse is​ accurate? A. ​"The client is at risk for weight​ loss." B. ​"The client is at risk for a micronutrient​ deficiency." C. ​"The client is at risk for a macronutrient​ deficiency." D. ​"The client is at risk for weight​ gain."

​D. "The client is at risk for weight​ gain." The client is at risk for weight gain associated with the treatment involving steroids and a decreased activity level during exacerbation of the disease. The client is not at risk for weight​ loss, micronutrient​ deficiency, or macronutrient deficiency unless the GI tract is compromised.