WEEK 11 POST TEST

1. A presentation on systemic lupus erythematosus (SLE) is being prepared

by the nurse. Which statement should the nurse include? Select all that
apply.  

The etiology is known to be linked to environmental factors.

Manifestations can be mild to fatal, with remissions and exacerbations.
The immune complex deposits trigger an inflammatory response.
SLE is a result of deposition of antigen-antibody complexes in connective
tissues.
The inflammatory response leads to anaphylactic shock.

Answer:

-Manifestations can be mild to fatal, with remissions and exacerbations.

-The immune complex deposits trigger an inflammatory response.
-SLE is a result of deposition of antigen-antibody complexes in connective
tissues.

Rationale: The pathophysiology of systemic lupus erythematosus is a result of

the formation of antigen-antibody immuno complexes 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.

2. A client with systemic lupus erythematosus (SLE) is being evaluated by the

nurse. Which clinical manifestation should the nurse expect to observe?
Select all that apply. 

Red butterfly rash on the face

Alopecia
Psoriatic lesions
Painful or swollen joints
Leg and eye edema

Answer:

Red butterfly rash on the face

Alopecia
Painful or swollen joints
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.
3. A client with systemic lupus erythematosus (SLE) is being assessed by the
nurse.  Which manifestation should the nurse recognize as a result of
inflammation? Select all that apply.

Cough
Malaise
Maculopapular rash
Joint pain
Fever

Answer:

Malaise
Maculopapular rash
Joint pain
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.

4. A patient diagnosed with systemic lupus erythematosus (SLE) is

experiencing pulmonary interstitial fibrosis. Which classification of lupus
should the nurse suspect?

Systemic
Drug-induced
Discoid
Cutaneous

Answer: 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).
5. 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?

Cardiac
Integumentary
Respiratory
Renal

Answer: Renal

Rationale: When the SLE auto antibodies 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.

6. Anemia is indicated by the patient's laboratory findings, who has systemic

lupus erythematosus (SLE). Which collaborative therapy the nurse should
anticipate? 

Performing a splenectomy
Treating the underlying cause
Administering corticosteroids
Administering erythropoietin

Answer: 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.
7. Which condition should the nurse initially suspect when a patient with a
history of systemic lupus erythematosus (SLE) says, "My chest hurts when I
lie down. I think it's from coughing so much. Please sit me up".

Anemia
Myocardial infarction
Pericarditis
Thrombocytopenia

Answer: 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.

8. Which of the following medications used to treat Systemic Lupus

Erythematosus immediately reduces inflammation, is not recommended for
long-term use, and can result in weight gain, infection susceptibility, diabetes,
and osteoporosis?

Hydroxychloroquine
Prednisone
Azathioprine
Belimumab
Answer: Prednisone
Rationale: The question above is describing steroids. Prednisone is a steroid
medication. These are medications used to treat lupus. They decrease
inflammation quickly, are not for long-term usage, and can lead to weight
gain, susceptibility to infection, diabetes, and osteoporosis.

9. A flare-up of Systemic Lupus Erythematosus has forced the hospitalization

of a 32 year old female patient. Now that the patient has recovered and is
about to be discharged.  The patient says she wants to get pregnant soon.
How long should the patient be advised to be in remission of this condition
before trying to conceive a baby? 

2 months
2 years
6 months
1 year

Answer: 6 months

Rationale: Women with lupus, who want to become pregnant, need to make
sure their lupus has been in control (hence remission….no flare-ups) for at
least 6 months before conceiving. This is because there is a risk of
miscarriage and clotting issues. Pregnancy and the post-partum period can
cause flares.
10. An elderly client is suffering from an acute episode of systemic lupus
erythematosus (SLE). Which primary concern should the nurse take into
consider when giving newly prescribed medications?

Neurological function
Cardiovascular function
Respiratory function
Renal function

Answer: 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.

11. A patient with a recent diagnosis of systemic lupus erythematosus

(SLE) is being instructed by the nurse. Which information should the nurse
include when educating the patient?
Using high-dose birth control pills
Avoiding large crowds
Using only acetaminophen for pain relief
Increasing daily sun exposure

Answer: 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

12. The nurse is reviewing the prescriptions for a 25 years old patient with
systemic lupus erythematosus (SLE) who was just admitted. Which
medication order should the nurse question?

Corticosteroid
Oral contraceptive
Immunosuppressive
Anti-neoplastic

Answer: 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.

13. A 30 years old female patient with systemic lupus erythematosus (SLE)
who complains of pain and discomfort is being cared for by the nurse. Which
treatment option should the nurse anticipate? Select all that apply.
Proper nutrition
Corticosteroids
NSAIDs
Increasing sun exposure
Moderate exercise

Answer:

Corticosteroids
Moderate exercise
NSAIDs

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.

14. Which laboratory test is used in the diagnosis of systemic lupus

erythematosus (SLE)? Select all that apply.

Triglyceride levels
Erythrocyte sedimentation rate (ESR)
Urinalysis
Complete blood count (CBC)
Anti-DNA antibody testing

Answer:

Erythrocyte sedimentation rate (ESR)

Urinalysis
Complete blood count (CBC)
Anti-DNA antibody testing

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.

15. The nurse is teaching a new nurse about the effects of medications used
for patients with systemic lupus erythematosus (SLE). Which of the new
nurse statements indicates the need for further teaching?
"When the client is on aspirin therapy, I should monitor for renal toxicity."
"Corticosteroid therapy can cause cushingoid effects."
"If a cytotoxic agent is prescribed, infection may occur."
"Thrombosis prevention is a positive side effect with aspirin therapy."

Answer: "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.

16. An adolescent patient with systemic lupus erythematosus (SLE) is

receiving care from the nurse. Which nursing diagnosis is a special
consideration for this patient?

Risk for Fluid Volume Deficit

Risk for Infection
Activity Intolerance
Disturbed Body Image

Answer: Disturbed Body Image

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 risk of fluid
volume deficit apply to all clients with SLE. Activity Intolerance is not a typical
clinical manifestation of SLE. 

17. The nurse is giving care to a patient in a community setting who has just
been diagnosed with systemic lupus erythematosus (SLE). What is the goal of
care for this client? Select all that apply.
Reducing pain
Preventing infections
Maintaining skin integrity
Reducing inflammation
Limiting fluid intake

Answer:

Reducing pain
Preventing infections
Maintaining skin integrity
Reducing inflammation

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.

18. A patient with systemic lupus erythematosus (SLE) is being admitted by

the nurse for an upper respiratory infection. Which nursing goal is the priority?

The client demonstrates proper hand hygiene.

The client can verbalize the impact of the diagnosis to the healthcare provider.
The client can verbalize the importance of oral care.
The client can verbalize skin care needs to reduce the risk of altered skin
integrity.

Answer: 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.

19. A patient with systemic lupus erythematosus (SLE) who is experiencing

alterations in skin integrity is receiving a teaching from the nurse. Which
patient statement indicates effective teaching?
"I will use fluorescent lighting."
"I will apply sunscreen immediately prior to going outdoors."
"I will limit the use of cosmetics."
"I will cover the lesions on my head with a wig."

Answer: "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.

20. A patient with an acute exacerbation of systemic lupus erythematosus

(SLE) is admitted to the hospital due to incapacitating fatigue, acute hand and
wrist pain, and proteinuria. The doctor prescribes prednisone (Deltasone) 40
mg twice daily. What nursing intervention should be included in the plan of
care?

Institute seizure precautions.

Reorient to time and place PRN.
Monitor intake and output.
Place on cardiac monitor.

Answer: Monitor intake and output.

Rationale: Lupus nephritis is a common complication of SLE, and when the

patient is taking corticosteroids, it is especially important to monitor renal
function. There is no indication that the patient is experiencing any nervous
system or cardiac problems with the SLE.

21. A 23 years old female patient with systemic lupus erythematosus (SLE)
who has  a facial rash and alopecia informs the nurse, "I hate the way I look! I
never go anyplace other than here to the health clinic".  What is the
appropriate nursing diagnosis for the patient? 
Activity intolerance related to fatigue and inactivity.
Impaired skin integrity related to itching and skin sloughing.
Social isolation related to embarrassment about the effects of SLE.
Impaired social interaction related to lack of social skills.

Answer: Social isolation related to embarrassment about the effects of SLE.

Rationale: The patient's statement about not going anyplace because of

hating the way he or she looks supports the diagnosis of social isolation
because of embarrassment about the effects of the SLE. Activity intolerance
is a possible problem for patients with SLE, but the information about this
patient does not support this as a diagnosis. The rash with SLE is non-pruritic.
There is no evidence of lack of social skills for this patient.

22. A patient with polyarthralgia with joint swelling and pain is being evaluated
for systemic lupus erythematosus (SLE). The nurse knows that the serum test
result that is the most suggestive for SLE is the presence of?

Rheumatoid factor
Anti-Smith antibody (Anti-Sm)
Antinuclear antibody (ANA)
Lupus erythematosus (LE) cell prep

Answer: Anti-Smith antibody (Anti-Sm)

Rationale: 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.

23. Before going for college, a 22 year old patient who is receiving
azathioprine (Imuran) for systemic lupus erythematosus had a checkup. The
doctor writes all of these orders. Which one should the nurse question?

Naproxen (Aleve) 200 mg BID

Give measles-mumps-rubella (MMR) immunization
Draw anti-DNA titer
Famotidine (Pepcid) 20 mg daily

Answer: Give measles-mumps-rubella (MMR) immunization

Rationale: Live virus vaccines, such as rubella, are contraindicated in a

patient taking immunosuppressive drugs. The other orders are appropriate for
the patient.

24. A patient may have systemic lupus erythematosus. The nurse monitors

the patient,  knowing that which of the following is one of the earliest
symptoms of systemic lupus erythematosus? 
Weight gain
Subnormal temperature
Elevated red blood cell count
Rash on the face across the bridge of the nose

Answer: Rash on the face across the bridge of the nose

Rationale: Skin lesions or rash on the face across the bridge of the nose and
on the cheeks is an initial characteristic sign of systemic lupus erythematosus
(SLE). Fever and weight loss may also occur. Anemia is most likely to occur
later in SLE.

25. A patient with systemic lupus erythematosus (SLE) is under the nurse's
care. The nurse plans care knowing that this disorder is?

A local rash that occurs as a result of allergy

A disease caused by overexposure to sunlight
An inflammatory disease of collagen contained in connective tissue
A disease caused by the continuous release of histamine in the body

Answer: An inflammatory disease of collagen contained in connective tissue

Rationale: Systemic Lupus Erythematosus (SLE) is a disease that can cause

inflammation of the connective tissue in every organ of the body, from the
brain, skin, blood, to the lungs. Collagen diseases are autoimmune diseases
that occur when the body's immune system attacks its own skin, tissues and
organs. It's nine times more common in women than in men.

26. A patient with systemic lupus erythematosus (SLE) who was admitted to

the hospital is under the nurse's care. The nurse looks over the doctor's
prescriptions. Which of the following medications would the nurse expect to
be prescribed?

Antibiotic
Antidiarrheal
Corticosteroid
Opioid analgesic

Answer: Corticosteroid

Rationale: Treatment of SLE is based on the systems involved and

symptoms. Treatment normally consists of anti-inflammatory drugs,
corticosteroids, and immunosuppressants. The incorrect options are not
standard components of medication therapy for this disorder.

27. A nurse is gathering information on a client who is experiencing anorexia,

weakness, malaise, muscle and joint pain at multiple locations, fatigue, and
photosensitivity. Suspected is systemic lupus erythematosus (SLE). Which of
the following is checked further by the nurse and is also indicative of the
presence of SLE? 

Emboli
Ascites
Two hemoglobin S genes
Butterfly rash on cheeks and bridge of nose

Answer: Butterfly rash on cheeks and bridge of nose

Rationale: SLE is a chronic inflammatory disease that affects multiple body

systems. A butterfly rash on the cheeks and on the bridge of the nose is a
classic sign of SLE. 

28. Which patient is at the highest risk for systemic lupus erythematous
(SLE)?

An Asian male
A white female
An African-American male
An African-American female

Answer: An African-American female

29. The patient being cared for by the nurse is a systemic lupus
erythematosus (SLE) patient who has been admitted to the hospital. While
checking the patient's test results, the nurse notices that the white blood cell
count (WBC) is decreased. Which nursing diagnosis for this patient is the
highest priority based on the information provided?

Ineffective Protection
Ineffective Health Maintenance
Ineffective Individual Coping
Risk for Impaired Skin Integrity

Answer: Ineffective Protection

Rationale: All identified diagnoses are appropriate for a client with SLE.
However, decreased in the WBC count indicates an increased risk for
infection. Therefore the priority for the client with the diagnosis Ineffective
Protection.

30. A patient with discoid lupus erythematosus is being cared for by the nurse.
The patient and the nurse are working together to create goals for the nursing
plan of care. What is the appropriate goal for this patient?
Work through the stages of death and dying.
Comply 100% of the time with a sun protection plan.
Gain weight to within 10 pounds of normal for height.
Report pain no higher than four on a scale of 1-10.

Answer: Comply 100% of the time with a sun protection plan.

Rationale: 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.