Lupus

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."

"I will limit the use of​ cosmetics." Rationale: 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 weight​ gain." D. ​"The client is at risk for a macronutrient​ deficiency."

"The client is at risk for weight​ gain." Rationale: 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.

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 erythropoietin D. Administering corticosteroids

Administering erythropoietin Rationale: 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.

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

Anti-DNA antibody testing Urinalysis Complete blood count​ (CBC) Erythrocyte sedimentation rate​ (ESR) Rationale: 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.

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. ​Memory, Impaired B. Fluid​ Volume: Imbalanced, Risk for C. Body​ Image, Disturbed D. ​Infection, Risk for

Body​ Image, Disturbed Rationale: 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)

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. Thrombocytopenia B. Myocardial infarction C. Pericarditis D. Anemia

Pericarditis Rationale: 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.

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. Renal B. Cardiac C. Integumentary D. Respiratory

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

SLE is a result of deposition of antigen-antibody complexes in connective tissues. Manifestations can be mild to​ fatal, with remissions and exacerbations. E. The immune complex deposits trigger an inflammatory response. Rationale: 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. Antineoplastic C. Oral contraceptive D. Immunosuppressive

oral contraceptive Rationale: 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 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. ​"If a cytotoxic agent is​ prescribed, infection may​ occur." B. ​"Thrombosis prevention is a positive side effect with aspirin​ therapy." C. ​"When the client is on aspirin​ therapy, I should monitor for renal​ toxicity." D. ​"Corticosteroid therapy can cause cushingoid​ effects."

​"When the client is on aspirin​ therapy, I should monitor for renal​ toxicity." Rationale: 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 nurse is admitting a client with systemic lupus erythematosus​ (SLE) for an upper respiratory infection. Which nursing goal is the priority​? A. The client can verbalize skin care needs to reduce the risk of altered skin integrity. 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 demonstrates proper hand hygiene

​. The client demonstrates proper hand hygiene Rationale: 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.

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. Alopecia B. Psoriatic lesions C. Painful or swollen joints D. Leg and eye edema E. Red butterfly rash on the face

​Alopecia Painful or swollen joints Leg and eye edema Red butterfly rash on the face 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.

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 only acetaminophen for pain relief B. Using​ high-dose birth control pills C. Increasing daily sun exposure D. Avoiding large crowds

​Avoiding large crowds Rationale: 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. Anemia B. Congenital heart block​ (CHB) C. Renal anomalies D. Liver involvement

​Congenital heart block​ (CHB) Rationale: 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.

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. Physical therapy to improve mobility B. Antibiotic therapy C. Surgical drainage of affected joints D. Corticosteroid therapy

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

​Maculopapular rash Malaise Joint pain Fever Rationale: 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 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. Increasing sun exposure B. Proper nutrition C. Moderate exercise D. NSAIDs E. Corticosteroids

​Moderate exercise NSAIDs Corticosteroids Rationale: 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.

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. Limiting fluid intake D. Reducing inflammation E. Maintaining skin integrity

​Reducing pain Preventing infections Reducing inflammation Maintaining skin integrity Rationale: 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.

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. Renal function B. Neurological function C. Respiratory function D. Cardiovascular function

​Renal function Rationale: 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.

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

​Systemic Rationale: 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).