Chapter 38 SLE

A client is diagnosed with systemic lupus erythematosus (SLE). Which of the following would be most appropriate for the nurse to use to evaluate the client' s stage of disease? A) Review the client's medical record. B) Auscultate the client's lung sounds. C) Inspect the client's mouth. D) Observe the client's gait.

A. Review the client's medical record. The nurse evaluates the stage of SLE and plans appropriate interventions by reviewing the medical record and diagnostic findings of the client. The stage of the disease cannot be established by observing the client's gait, inspecting the client's mouth, or auscultating the client's lung sounds.

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 the apply): A) Positive ANA titer B) Increased hemoglobin C) 2+ urine protein D) Increased serum C3 and C4 E) Elevated BUN

A) Positive ANA titer C) 2+ urine protein E) Elevated BUN A. CORRECT: A positive antinuclear antibody (ANA) titer is an expected finding in a client who has SLE. The ANA test identifies the presence of antibody produced against the client's own DNA. C. CORRECT: Increased urine protein is an expected finding due to renal involvement as a result of SLE. E. CORRECT: Elevated BUN is an expected finding due to renal involvement in a client who has SLE.

Which of the following disorders is characterized by an increased autoantibody production? A) Systemic lupus erythematosus (SLE) B) Scleroderma C) Rheumatoid arthritis (RA) D) Polymyalgia rheumatic

A) Systemic lupus erythematosus (SLE) Explanation: SLE is an immunoregulatory disturbance that results in increased autoantibody production. Scleroderma occurs initially in the skin but also occurs in blood vessels, major organs, and body systems, potentially resulting in death. Rheumatoid arthritis results from an autoimmune response in the synovial tissue, with damage taking place in body joints. In polymyalgia rheumatic, immunoglobulin is deposited in the walls of inflamed temporal arteries.

A patient who has been newly diagnosed with systemic lupus erythematosus (SLE) has been admitted to the medical unit. Which of the following nursing diagnoses is the most plausible inclusion in the plan of care? A)Fatigue Related to Anemia B)Risk for Ineffective Tissue Perfusion Related to Venous Thromboembolism C)Acute Confusion Related to Increased Serum Ammonia Levels D)Risk for Ineffective Tissue Perfusion Related to Increased Hematocrit

A. Fatigue related to anemia Patients with SLE nearly always experience fatigue, which is partly attributable to anemia. Ammonia levels are not affected and hematocrit is typically low, not high. VTE is not one of the central complications of SLE.

A patient with an exacerbation of systemic lupus erythematosus (SLE) has been hospitalized on the medical unit. The nurse observes that the patient expresses anger and irritation when her call bell isn't answered immediately. What would be the most appropriate response? A)You seem like you're feeling angry. Is that something that we could talk about? B) Try to remember that stress can make your symptoms worse. C) Would you like to talk about the problem with the nursing supervisor? D) I can see you're angry. I'll come back when you've calmed down.

A. You seem like you're feeling angry. Is that something that we could talk about? The changes and the unpredictable course of SLE necessitate expert assessment skills and nursing care, as well as sensitivity to the psychological reactions of the patient. Offering to listen to the patient express anger can help the nurse and the patient understand its cause and begin to deal with it. Although stress can exacerbate the symptoms of SLE, telling the patient to calm down doesnt acknowledge her feelings. Ignoring the patients feelings suggests that the nurse has no interest in what the patient has said. Offering to get the nursing supervisor also does not acknowledge the patients feelings.

A nurse assesses a client in the health care provider's office. Which assessment findings support a suspicion of systemic lupus erythematosus (SLE)?' A.) Facial erythema, pericarditis, pleuritis, fever, and weight loss B.) Photosensitivity, polyarthralgia, and painful mucous membrane ulcers C.) Weight gain, hypervigilance, hypothermia, and edema of the legs D.) Hypothermia, weight gain, lethargy, and edema of the arms

A.) Facial erythema, pericarditis, pleuritis, fever, and weight loss An autoimmune disorder characterized by chronic inflammation of the connective tissues, SLE causes fever, weight loss, malaise, fatigue, skin rashes, and polyarthralgia. Nearly half of clients with SLE have facial erythema, (the classic butterfly rash). SLE also may cause profuse proteinuria (excretion of more than 0.5 g/day of protein), pleuritis, pericarditis, photosensitivity, and painless mucous membrane ulcers. Weight gain, hypervigilance, hypothermia, and edema of the legs and arms don't suggest SLE.

Which client is most likely to develop systemic lupus erythematosus (SLE)? A) A 25-year-old white male B) A 25-year-old Jewish female C) A 27-year-old black female D) A 35-year-old Hispanic male

C) A 27-year-old black female SLE strikes nearly 10 times as many women as men and is most common in women between ages 15 and 40. SLE affects more black women than white women; its incidence is about 1 in every 250 black women, compared to 1 in every 700 white women.

A client has had several diagnostic tests to determine if he has systemic lupus erythematosus (SLE). What result is very specific indicator of this diagnosis? A.) Positive Anti-dsDNA antibody test B.) Positive Anti-Sm antibodies C.) Positive ANA titer D.) Elevated ESR

Answer: A.) Positive Anti-dsDNA antibody test Rationale: Anti-double-stranded DNA (anti-dsDNA) antibody test is a test that shows high titers of antibodies against native DNA. This is very specific for SLE because this test is not positive for other autoimmune disorders. Anti-Smith (anti-Sm) antibodies are specific for SLE, but are found in only 20% to 30% of clients with SLE. ANA titer shows the presence of an autoimmune disease but is not specific to SLE. The other lab studies may also indicate multisystem involvement.

A nurse is preparing a client with systemic lupus erythematosus (SLE) for discharge. Which instruction should the nurse include in the teaching plan? A.) "Exposure to sunlight will help control skin rashes." B.) "There are no activity limitations between flare-ups." C.) "Monitor your body temperature." D.) "Corticosteroids may be stopped when symptoms are relieved."

Answer: C.) "Monitor your body temperature." Rationale: The nurse should instruct the client to monitor body temperature. Fever can signal an exacerbation and should be reported to the physician. Sunlight and other sources of ultraviolet light may precipitate severe skin reactions and exacerbate the disease. Fatigue can cause a flare-up of SLE. Clients should be encouraged to pace activities and plan rest periods. Corticosteroids must be gradually tapered because they can suppress the function of the adrenal gland. Abruptly stopping corticosteroids can cause adrenal insufficiency, a potentially life-threatening situation.

Which assessment suggests to the nurse that a client with systemic lupus erythematous is having renal involvement? A.) Chest pain B.) Decreased cognitive ability C.) Behavioral changes D.) Hypertension

Answer: D.) Hypertension Hypertension is suggestive of renal damage in the client with systemic lupus erythematous.

A nurse is performing the initial assessment of a patient who has a recent diagnosis of systemic lupus erythematosus (SLE). What skin manifestation would the nurse expect to observe on inspection? A) Petechiae B) Butterfly rash C) Jaundice D) Skin sloughing

B) Butterfly Rash An acute cutaneous lesion consisting of a butterfly-shaped rash across the bridge of the nose and cheeks occurs in SLE. Petechiae are pinpoint skin hemorrhages, which are not a clinical manifestation of SLE. Patients with SLE do not typically experience jaundice or skin sloughing.

A client is being discharged from the hospital after being diagnosed with and treated for systemic lupus erythematosus (SLE). What would the nurse not include when teaching the client and family information about managing the disease? A) Maintain a well-balanced diet and increase fluid intake to raise energy levels and promote tissue healing. B) Avoid sunlight and ultraviolet radiation. C) If you have problems with a medication, you may stop it until your next physician visit. D) Pace activities.

C) If you have problems with a medication, you may stop it until your next physician visit. Take medications exactly as directed and do not stop the medication if symptoms are relieved unless advised to do so by the physician.-Sunlight tends to exacerbate the disease.-Because fatigue is a major issue, allow for adequate rest, along with regular activity to promote mobility and prevent joint stiffness.-Maintain a well-balanced diet and increase fluid intake to raise energy levels and promote tissue healing.

A patient with systemic lupus erythematosus (SLE) is preparing for discharge. The nurse knows that the patient has understood health education when the patient makes what statement? A)I'll make sure I get enough exposure to sunlight to keep up my vitamin D levels. B)I'll try to be as physically active as possible between flare-ups. C)I'll make sure to monitor my body temperature on a regular basis. D)I'll stop taking my steroids when I get relief from my symptoms.

C. I'll make sure to monitor my body temperature on a regular basis. Fever can signal an exacerbation and should be reported to the physician. Sunlight and other sources of ultraviolet light may precipitate severe skin reactions and exacerbate the disease. Fatigue can cause a flare-up of SLE. Patients should be encouraged to pace activities and plan rest periods. Corticosteroids must be gradually tapered because they can suppress the function of the adrenal gland. As well, these drugs should not be independently adjusted by the patient.

A patient with SLE has come to the clinic for a routine check-up. When auscultating the patients apical heart rate, the nurse notes the presence of a distinct scratching sound. What is the nurses most appropriate action? A)Reposition the patient and auscultate posteriorly. B)Document the presence of S3 and monitor the patient closely. C)Inform the primary care provider that a friction rub may be present. D)Inform the primary care provider that the patient may have pneumonia.

C. Inform the primary care provider that a friction rub may be present. Patients with SLE are susceptible to developing a pericardial friction rub, possibly associated with myocarditis and accompanying pleural effusions; this warrants prompt medical follow-up. This finding is not characteristic of pneumonia and does not constitute S3. Posterior auscultation is unlikely to yield additional meaningful data.

A patient with SLE asks the nurse why she has to come to the office so often for check-ups. What would be the nurses best response? A)Taking care of you in the best way involves seeing you face to face. B)Taking care of you in the best way involves making sure you are taking your medication the way it is ordered. C)Taking care of you in the best way involves monitoring your disease activity and how well the prescribed treatment is working. D)Taking care of you in the best way involves drawing blood work every month.

C. Taking care of you in the best way involves monitoring your disease activity and how well the prescribed treatment is working. The goals of treatment include preventing progressive loss of organ function, reducing the likelihood of acute disease, minimizing disease-related disabilities, and preventing complications from therapy. Management of SLE involves regular monitoring to assess disease activity and therapeutic effectiveness. Stating the benefit of face-to-face interaction does not answer the patients question. Blood work is not necessarily drawn monthly and assessing medication adherence is not the sole purpose of visits.

A client suspected of having systemic lupus erythematosus (SLE) is being scheduled for testing. The client asks which of the tests ordered will determine positivity for the disorder. Which statement by the nurse is most accurate? A) "You should discuss that matter with your health care provider." B) "SLE is a very serious systemic disorder." C) "Tell me more about your concerns about this potential diagnosis." D) "The diagnosis won't be based on the findings of a single test but by combining all data found."

D) "The diagnosis won't be based on the findings of a single test but by combining all data found." Rationale: There is no single test available to diagnose SLE. Therefore, the nurse should inform the client that diagnosis is based on combining the findings from the physical assessment and the laboratory tests results. Advising the client to speak with the health care provider, stating that SLE is a serious systemic disorder, and asking the client to express feelings about the potential diagnosis do not answer the client's question.

The nurse is teaching the client newly diagnosed with systemic lupus erythematous about the condition. Which statement by the client indicates teaching was effective? A.) "My energy level will gradually increase over time." B.) "My medications will ultimately correct my problem." C.) "I do not need to make any changes in my diet." D.) "I should avoid prolonged sun exposure."

D.) "I should avoid prolonged sun exposure." Prolonged exposure to sun and ultraviolet light can cause exacerbations and disease progression.

The nurse is teaching a newly diagnosed client about systemic lupus erythematosus(SLE). What statement by the client indicates the teaching was successful? A) "The belief is that it is an autoimmune disorder with an unknown trigger." B) "This disorder is more common in men in their thirties and forties than in women." C) "SLE has very specific manifestations that make diagnosis relatively easy." D) "The symptoms are primarily localized to the skin but may involve the joints."

a) "The belief is that it is an autoimmune disorder with an unknown trigger." Systemic lupus erythematosus is believed to be an autoimmune disorder but the triggering mechanism is not known. The disorder is more common in women than in men, most with the disorder in the 3rd or 4th decade of life. The disease is considered the "great imitator" because the clinical signs resemble many other conditions. SLE is a diffuse connective tissue disease that affects multiple body systems.

A physician orders corticosteroids for a child with systemic lupus erythematosus (SLE). The nurse knows that the purpose of corticosteroid therapy for this child is to:

combat inflammation. Corticosteroids are used to combat inflammation in a child with SLE. To prevent infection, the physician would order antibiotics. Aspirin is used to prevent platelet aggregation. Diuretics, not corticosteroids, promote diuresis.

The nurse is working with a client with systemic lupus erythematosus (SLE). What are the immune abnormalities characterized by SLE? Select all that apply. A) inflammation B) damage C) abnormal innate and adaptive immune responses D) autoantibodies immune complexes E) susceptibility

susceptibility abnormal innate and adaptive immune responses autoantibodies immune complexes inflammation damage The immune abnormalities that characterize SLE occur in five phases: susceptibility, abnormal innate and adaptive immune responses, autoantibodies immune complexes, inflammation, and damage.