Lupus (systemic lupus erythematosus (SLE)) (LPN)

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

C) 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. Next Question

The nurse is caring for a pregnant client with lupus (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) Renal anomalies B) Congenital heart block (CHB) C) Liver involvement D) Anemia

B) 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.

Which of the following manifestations in not associated with lupus (SLE)? A) Symmetric polyarthritis B) Excess hair growth C) Thrombocytopenia D) Pleural effusions

B) Excess hair growth Rationale: Common manifestations of SLE include symmetric polyarthritis, thrombocytopenia, and pleural effusions. Alopecia (hair loss) is also associated with SLE; excess hair growth is not.

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

D) 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).

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

A, B, C, D 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.

The nurse is providing care for a newly married woman with lupus (SLE). Which statement on the part of the client indicates an appropriate understanding of the plan of care? 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 a concert this weekend so that I get out of the house." D) "I can take aspirin as indicated for pain."

A) "I will take birth control pills while I am taking cytotoxic medications." Rationale: Treatment for SLE may include cytotoxic drugs. Because these drugs can cause birth defects, women who take them should be advised to avoid pregnancy by using contraceptives. Clients with SLE should also be taught to avoid crowds, because they are potential sources of infection. Aspirin can cause bleeding, so it should be taken only with extreme care. Also, clients with SLE should contact their primary care provider whenever signs of infection occur, because it means their immune system is compromised.

The nurse is caring for a client with exacerbation of lupus (SLE). Which statement by the nurse is accurate? A) "The client is at risk for weight gain." 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 loss."

A) "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.

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

A) 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.

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

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

A) 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)

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

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

A) Risk for infection Rationale: All identified diagnoses are appropriate for a client with SLE. However, the shift to the left in the WBC count is indicative of a large number of immature cells, suggesting infection. Therefore, the priority diagnosis is Risk for Infection.

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 the nose and on the cheeks. Based on this data, which diagnosis should the nurse anticipate? A) Systemic lupus erythematosus B) Fibromyalgia C) Lyme disease D) Gout

A) Systemic lupus erythematosus Rationale: A "butterfly rash" that covers the bridge of the nose and the cheeks is a characteristic manifestation of systemic lupus erythematosus (SLE). Although fibromyalgia, Lyme disease, and gout all share some symptoms with SLE (e.g., joint pain and/or fatigue), they are not associated with a rash over the nose and cheeks.

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

A, B, C 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.

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

A, B, C, E 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.

A nurse is caring for a client with lupus (SLE) who is prescribed immunosuppressive therapy. When providing teaching for this client, which statements are appropriate for the nurse to include? SATA A) "Avoid large crowds and situations that increase your exposure to infection." B) "Report any cough or difficulty breathing to the physician if you are taking cyclophosphamide." C) "Use aspirin instead of acetaminophen if you develop a fever." D) "Heavy menstrual bleeding may occur during therapy." E) "Be sure to drink plenty of liquids."

A, B, E Rationale: Clients who are on immunosuppressant therapy for SLE should be advised to avoid large crowds and situations that increase their exposure to infection; to report difficulty breathing or a cough; and to maintain adequate oral hydration. The client should report a fever if it develops, but aspirin should not be used, as this may increase the risk for bleeding. Also, women may have an absence of menstruation, not heavy bleeding, during therapy.

A female client with lupus (SLE) is being treated with immunosuppressant drugs and corticosteroids. When providing teaching to this client, which of the following points are appropriate for the nurse to include? SATA A) Avoid large crowds B) Don't get a flu shot C) Use contraception to prevent pregnancy D) Refrain from taking aspirin products E) Report any signs of infection to the HCP

A, C, D, E Rationale: Crowds may increase exposure to infection, which is potentially dangerous for clients who are taking immunosuppressants. Annual influenza vaccination is recommended, although clients with significant immunosuppression should not receive live vaccines. Immunosuppressive drugs may increase the risk of birth defects, so contraception is important. Aspirin products may increase the risk of bleeding, which would further impair immune function. Chills, fever, sore throat, fatigue, or malaise should be reported so related infections can be treated as quickly as possible.

Which laboratory test is used in the diagnosis of lupus (SLE)? SATA A) Erythrocyte sedimentation rate (ESR) B) Triglyceride levels C) CBC D) Anti-DNA antibody testing E) Urinalysis

A, C, D, E 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.

A nurse is caring for a client with lupus (SLE). The client begins to cry, stating, "I am afraid I will be disfigured because of all these lesions." Which interventions should the nurse plan to teach the client to minimize the risk of skin infections associated with SLE? SATA 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 1000-1500 E) Use fluorescent lighting indoors

A, D Rationale: Clients with SLE can live a normal life, but they should take a few extra precautions to minimize the risk of skin lesions. For example, because there is a relationship between sun exposure and infection, the client should be 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 as long as the above precautions are taken. When indoors, the client should try to avoid fluorescent lighting, as exacerbations of SLE have been reported following exposure.

*Possible exam question* Which of the following hormonal changes would most likely result in an exacerbation of lupus (SLE)? A) Increase in testosterone levels B) Increase in estrogen levels C) Increase in overall androgen levels D) Increase in serotonin levels

B) Increase in estrogen levels Rationale: Sex hormones are thought to influence the development of SLE. In particular, increased estrogen levels and reduced androgen levels are shown to enhance antibody responses and have an adverse effect in clients with SLE. Testosterone is an androgen, so increased testosterone levels likely would not exacerbate SLE. Serotonin is a neurotransmitter and typically not considered a hormone, and it does not play a direct role in the exacerbation of SLE.

A client with a history of lupus (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) Pericarditis C) Anemia D) Myocardial infarction

B) 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.

A nurse is caring for a client diagnosed with discoid lupus erythematosus. The nurse is collaborating with this client to set goals for the nursing plan of care. Based on the information given here, which of the following would be an appropriate goal for this client? A) Learn strategies to cope with death and the dying process B) Remain compliant with a sun protection plan C) Gain weight to within 10 pounds of normal for height D) Report pain no higher than 3 on a scale of 0 to 10

B) Remain compliant with a sun protection plan Rationale: Discoid lupus erythematosus is an autoimmune disorder of the skin, so clients must protect their skin against the sun to avoid exacerbations. The other goals are not appropriate because discoid lupus erythematosus is not fatal, is not related to weight, and is rarely painful unless complications arise.

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

B) 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.

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

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

B, C, E 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.

*Possible exam question* A client asks the nurse whether there are any conditions that can exacerbate lupus (SLE). Which response by the nurse is the most appropriate? A) "Conditions that cause hypotension often worsen SLE." B) "GI upset is often associated with SLE exacerbation." C) "Pregnancy is often associated with a worsening of SLE." D) "Fever is a known trigger for SLE exacerbation."

C) "Pregnancy is often associated with a worsening of SLE." Rationale: Pregnancy can be associated with an exacerbation of SLE due to the associated rise in estrogen levels. Hypotension, fever, and GI upset are not factors that risk exacerbation of SLE.

A nurse is caring for a client with lupus (SLE) who is taking hydroxychloroquine (Plaquenil). When providing care for this client, the nurse should monitor for which adverse effect associated with this medication? A) Pulmonary fibrosis B) Cushingoid effects C) Retinal toxicity D) Renal toxicity

C) Retinal toxicity Rationale: Hydroxychloroquine (Plaquenil) is an antimalarial drug that is also used 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.

*Possible exam question* Why is kidney damage often observed in clients with lupus (SLE)? A) SLE involves unusually high levels of circulating antigens. Because the kidneys play a critical role in filtering these antigens from the blood; they are under excess stress in clients with SLE. B) SLE is commonly treated with NSAIDs. Because these medications carry a high risk of nephrotoxicity, their use often leads to kidney damage in clients with SLE. C) SLE involves deposition of immune complexes in the body's connective tissues. Because connective tissue makes up a significant portion of the kidneys, these organs are a frequent site of damage in SLE D) SLE involves unusually high levels of circulating antibodies. Because the kidneys play a critical role in filtering these antibodies from the blood, they are under excess stress in clients with SLE.

C) SLE involves deposition of immune complexes in the body's connective tissues. Because connective tissue makes up a significant portion of the kidneys, these organs are a frequent site of damage in SLE Rationale: SLE involves deposition of antigen-antibody complexes, also known as immune complexes, in the body's connective tissues. Because connective tissues makes up a large portion of the kidneys, these organs are frequently damaged in SLE. Note that the kidneys do not filter either antigens or antibodies from the blood. Also, even though NSAIDs are commonly used in the treatment of SLE and may exert nephrotoxic effects, use of NSAIDs is not the primary reason why kidney damage is often observed in clients with SLE.

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

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

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

D) "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.

*Possible exam question* A nurse is providing health education at several neighborhood community centers. The nurse adjusts the teaching plan based on the demographic characteristics of the clients that each center serves. For which of the following community centers should the nurse plan on providing signs and symptoms of lupus (SLE)? A) A community center that primarily serves young female children B) A community center that primarily serves young males of African American descent C) A community center that primarily serves Caucasian women D) A community center that primarily serves females of Asian descent

D) A community center that primarily serves females of Asian descent Rationale: SLE is more common among women than men, and it most often affects women of childbearing age. Furthermore, SLE is more common in African Americans, Hispanics, Native Americans, Native Hawaiians, and Asians than it is in Caucasians

A client diagnosed with lupus (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) Antibiotic therapy B) Surgical drainage of affected joints C) Physical therapy to improve mobility D) Corticosteroid therapy

D) 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 planning care for an adolescent client who has lupus (SLE). Which action by the client indicates the implemented plan of care is appropriate? A) Refusing to attend school B) Refraining from attending social functions C) Discussing skin changes with the HCP D) Discussing skin changes with a good friend

D) Discussing skin changes with a good friend Rationale: 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.