Chapter 38: SLE
A new clinic patient with joint swelling and pain is being tested for systemic lupus erythematosus. Which test will provide the most specific findings for the nurse to review? Rheumatoid factor (RF) Antinuclear antibody (ANA) Anti-Smith antibody (Anti-Sm) Lupus erythematosus (LE) cell prep
Ans: Anti-Smith antibody (Anti-Sm) 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.
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
Ans: Butterfly rash Feedback: 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 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: a) combat inflammation. b) prevent platelet aggregation c) promote diuresis. d) prevent infection.
combat inflammation. Explanation: 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. pg.1071
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.
Ans: Taking care of you in the best way involves monitoring your disease activity and how well the prescribed treatment is working. Feedback: 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 patient with an exacerbation of systemic lupus erythematosus (SLE) has been hospitalized on the medical unit. The nurse observes that the patient expresses angerand 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."
Ans: "You seem like you're feeling angry. Is that something that we could talk about?" Explanation: (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 doesn't acknowledge her feelings. Ignoring the patient's 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 patient's feelings.)
Which client is most likely to develop systemic lupus erythematosus (SLE)? a) A 27-year-old black female b) A 25-year-old white male c) A 35-year-old Hispanic male d) A 25-year-old Jewish female
Ans: A 27-year-old black female Explanation: 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. pg.1069
The health care provider has prescribed the following collaborative interventions for a patient who is taking azathioprine (Imuran) for systemic lupus erythematosus. Which order will the nurse question? Draw anti-DNA blood titer. Administer varicella vaccine. Naproxen (Aleve) 200 mg BID. Famotidine (Pepcid) 20 mg daily.
Ans: Administer varicella vaccine. Live virus vaccines, such as varicella, are contraindicated in a patient taking immunosuppressive drugs. The other orders are appropriate for the patient.
A physician orders tests to determine if a client has systemic lupus erythematosus (SLE). Which test result helps to confirm an SLE diagnosis? a) Increased total serum complement levels b) Negative antinuclear antibody test c) An above-normal anti-deoxyribonucleic acid (DNA) test d) Negative lupus erythematosus cell test
Ans: An above-normal anti-deoxyribonucleic acid (DNA) test Explanation: Laboratory results specific for SLE include an above-normal anti-DNA test, a positive antinuclear antibody test, and a positive lupus erythematosus cell test. Because the anti-DNA test rarely is positive in other diseases, this test is important in diagnosing SLE. (The anti-DNA antibody level may be depressed in clients who are in remission from SLE.) Decreased total serum complement levels indicate active SLE. pg.1070
A nurse assesses a client in the physician's office. Which assessment findings support a suspicion of systemic lupus erythematosus (SLE)? a) Photosensitivity, polyarthralgia, and painful mucous membrane ulcers b) Weight gain, hypervigilance, hypothermia, and edema of the legs c) Hypothermia, weight gain, lethargy, and edema of the arms d) Facial erythema, pericarditis, pleuritis, fever, and weight loss
Ans: Facial erythema, pericarditis, pleuritis, fever, and weight loss Explanation: 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. pg.1070
A patient with SLE has come to the clinic for a routine check-up. When auscultating the patient's apical heart rate, the nurse notes the presence of a distinct "scratching" sound. What is the nurse's 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.
Ans: Inform the primary care provider that a friction rub may be present Explanation: 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.
The nurse teaches a patient diagnosed with systemic lupus erythematosus (SLE) about plasmapheresis. What instructions about plasmapheresis should the nurse include in the teaching plan? Plasmapheresis will eliminate eosinophils and basophils from blood. Plasmapheresis will remove antibody-antigen complexes from circulation. Plasmapheresis will prevent foreign antibodies from damaging various body tissues. Plasmapheresis will decrease the damage to organs caused by attacking T lymphocytes.
Ans: Plasmapheresis will remove antibody-antigen complexes from circulation. Plasmapheresis is used in SLE to remove antibodies, antibody-antigen complexes, and complement from blood. T lymphocytes, foreign antibodies, eosinophils, and basophils do not directly contribute to the tissue damage in 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) Auscultate the client's lung sounds. b) Observe the client's gait. c) Review the client's medical record. d) Inspect the client's mouth.
Ans: Review the client's medical record. Explanation: 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. pg.1070
A 29-year-old woman 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? Weigh yourself daily to monitor for weight gain caused by increased appetite. A weight-bearing exercise program will help minimize the risk for osteoporosis. The prednisone dose should be decreased gradually rather than stopped suddenly. Call the health care provider if you experience mood alterations with the prednisone.
Ans: The prednisone dose should be decreased gradually rather than stopped suddenly. 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.
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."
Ans: "I'll make sure to monitor my body temperature on a regular basis." Explanation: 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.
Which result for a 30-year-old patient with systemic lupus erythematosus (SLE) is most important for the nurse to communicate to the health care provider? Decreased C-reactive protein (CRP) Elevated blood urea nitrogen (BUN) Positive antinuclear antibodies (ANA) Positive lupus erythematosus cell prep
Ans: Elevated blood urea nitrogen (BUN) The elevated BUN and creatinine levels indicate possible lupus nephritis and a need for a change in therapy to avoid further renal damage. The positive lupus erythematosus (LE) cell prep and ANA would be expected in a patient with SLE. A drop in CRP shows an improvement in the inflammatory process.
The immune abnormalities that characterize systemic lupus erythematosus (SLE) include which of the following? Select all that apply. a) Autoantibodies immune complexes b) Susceptibility c) Damage d) Abnormal innate and adaptive immune responses e) Inflammation
Ans: Susceptibility Abnormal innate and adaptive immune responses Autoantibodies immune complexes Inflammation Damage Explanation: The immune abnormalities that characterize SLE occur in five phases: susceptibility, abnormal innate and adaptive immune responses, autoantibodies immune complexes, inflammation, and damage.
A client suspected of having systemic lupus erythematosus (SLE) is being scheduled for testing. She asks which of the tests ordered will determine if she is positive for the disorder. Which statement by the nurse is most accurate? a) "You should discuss that matter with your physician." b) "Tell me more about your concerns about this potential diagnosis." c) "The diagnosis won't be based on the findings of a single test but by combining all data found." d) "SLE is a very serious systemic disorder."
"The diagnosis won't be based on the findings of a single test but by combining all data found." Explanation: 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 physician, stating that SLE is a serious systemic disorder, and asking the client to express her feelings about the potential diagnosis don't answer the client's question. pg.1070
A patient with SLE asks the nurse why she has to come to the office so often for "check-ups." What would be the nurse's 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."
Ans: "Taking care of you in the best way involves monitoring your disease activity and how well the prescribed treatment is working." Explanation: 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 patient's question. Blood work is not necessarily drawn monthly and assessing medication adherence is not the sole purpose of visits.)
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) Ill make sure I get enough exposure to sunlight to keep up my vitamin D levels. B) Ill try to be as physically active as possible between flare-ups. C) Ill make sure to monitor my body temperature on a regular basis. D) Ill stop taking my steroids when I get relief from my symptoms.
Ans: Ill make sure to monitor my body temperature on a regular basis. Feedback: 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 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
Ans: A Fatigue Related to Anemia Feedback: 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.
Which of the following suggests to the nurse that the client with systemic lupus erythematous is having renal involvement? a) Hypertension b) Chest pain c) Behavioral changes d) Decreased cognitive ability
Hypertension Explanation: Hypertension is suggestive of renal damage in the client with systemic lupus erythematous. pg.1070