Exemplar 8.4: Systemic Lupus Erythematosus

Question 1 of 14

1

You have a young female nursing student just diagnosed with lupus. She's heard of this disorder, but knows very little about it and decides to ask you, the university nurse, about it. Which of the following statements made by the student nurse shows that teaching has been effective?

Select one of the following:

"My body is producing antibodies against itself because of hyperreactive T-cell function."
"The most characteristic autoantibodies in SLE are produced in response to nucleic acids."
"The autoantibodies react with their corresponding antigen to form immune complexes that deposit into the body's blood vessels."
"The coronary blood vessels are a frequent site of complex deposition and change."

Explanation

Question 2 of 14

1

A 20-year-old female patient presents to you because she's had a 100.1 degree Fahrenheit fever, appetite loss, and pain in both elbows, wrists, shoulders, ankles. and knees for the past 2 weeks. She tells you she's lost about 6 pounds and she has had a hard time concentrating on schoolwork because hasn't "felt very good", though she can't identify why. She explains that this has been happening on and off for the past two years, but she hasn't gone to the doctor about it because her symptoms haven't been this troublesome before.

What follow up question would you want to ask this patient?

Select one of the following:

"Have you had any fungal infections lately?"
"Are you on any antipsychotic medications?"
"Have you ever gotten a red rash on your cheeks and the bridge of your nose?"
"Have you had regular menses?"

Explanation

Question 3 of 14

1

You are a nurse in a doctor's office about to see a male patient that has been taking procainamide for a little over a year. What questions might you ask this patient when he comes in?

Select one or more of the following:

"Have you been experiencing any new pain in your joints?"
"Have you been experiencing any new or increasing memory loss, disorientation, personality changes, depression, or psychoses?"
"Have you been noticing foamy urine, swelling in your abdomen and extremities, and weight gain?"
"Have you had diarrhea, abdominal pain, nausea, and decreased desire to eat?"
"Have you had any raised, scaly, circular lesions that has redness around them?"
"Have you been fatigued and experiencing bleeding gums, nosebleeds, or increased bruising?"

Explanation

Question 4 of 14

1

Select the medications that have potential to cause drug-induced lupus.

Select one or more of the following:

Procainamide
Hydralazine
Isoniazid
Sertraline
Hydroxychloroquinolone
Prednisolone

Explanation

Question 5 of 14

1

Your female lupus patient is presenting with severe weakness, fatigue, dyspnea, and heart palpitations. She reports that her grades have been dropping because she's too exhausted to do anything and she can't concentrate. She is pale, her skin is cold, and the tips of her fingers are slightly cyanotic.

Her heart rhythm is sinus rhythm; upon auscultation, S1 and S2 could clearly be heard, no extra sounds or murmurs identified. Her hematocrit is 22% and her hemoglobin is 7.5 g/dL.

Which of the following orders should you place FIRST?

Select one of the following:

ECG
Retake the CBC
50 units/kg epoetin alpha, subcutaneous
1 unit of blood of the appropriate blood type

Explanation

Question 6 of 14

1

A patient with lupus is in the doctor's office during a flare up. She complaining about getting random nose bleeds, gum bleeds, and bruising. She is embarrassed to wear skirts and short sleeved shirts because of the extensive bruising and "bumpy, non-itchy rashes" (petechiae) on her skin. It is even interfering with her relationship with her fiance; due to the extensive bruising and the patient trying to cover it up, people will assume that her fiance is abusing her and act judgmentally.

Which of the following orders will you suggest to the doctor for this patient?

Select one of the following:

5 mg prednisone, PO, BID.
Hospital referral for IV platelet transfusion
Hospital referral for IV IgG
1 mg/kg azathioprine IV BID for 6-8 wks

Explanation

Question 7 of 14

1

A lupus patient presents with chest pain radiating to his back., dry cough, fever, and anxiety. He reports that he is very tired, but he can't lay down and rest because that makes the pain worse. He is pale and cold. Upon auscultation you hear a high-pitched grating sound, no crackles or rales in the lungs. Telemetry and ECG shows ST elevation and PR depression.

Which of the following interventions should you order FIRST?

Select one of the following:

Pericardiocentesis
40 mg prednisone, PO, BID.
1,000 mg nafcillin PO, QID
1.2 mg colchicine PO, then 0.6 mg 1 hr later

Explanation

Question 8 of 14

1

You are concerned that the patient you are caring for might have systemic lupus erythematosus. Which tests might you order?

Select one or more of the following:

Anti-DNA antibody testing.
Erythrocyte sedimentation rate.
Serum complement levels.
Complete blood count
Enzyme-linked immunoabsorbent array.
Western blot antibody testing

Explanation

Question 9 of 14

1

You have a patient presenting to the hospital with anasarca, with increased edema in the hands, feet, and face; fatigue; anorexia; and foamy urine. This patient has been diagnosed with lupus in the past. What tests might you order?

Select one or more of the following:

Urinalysis
Renal function tests
Anti-DNA antibody testing
Erythrocyte sedimentation rate

Explanation

Question 10 of 14

1

Which of the following instructions is important to give to a female patient taking hydroxychloroquine?

Select one of the following:

"You should see an ophthalmologist every 6 months."
"Avoid large crowds and situations that increase exposure to infection."
"Refrain from taking aspirin or ibuprofen."
"Your menses may cease while taking the drug."

Explanation

Question 11 of 14

1

What are your responsibilities when taking care of a patient on IV azathioprine?

Select one or more of the following:

Monitor white blood cell and platelet counts.
Monitor creatinine, BUN, creatinine clearance, and liver enzyme levels.
Administer with food.
Increase fluids & monitor I&O
Monitor for petechiae & ask the patient to report bleeding gums, joint pain, hematuria, and black or tarry stools.
Monitor pulmonary function studies.

Explanation

Question 12 of 14

1

You have just taught a patient about precautions to take to prevent infection while taking cyclophosphamide. Which of the following statements made by the patient shows that teaching has been effective?

Select one of the following:

"I need to call my doctor if I start having difficulty breathing."
"I can still go to a house party Saturday."
"Ibuprofen may be helpful for pain relief."
"If I stop menstruating, I should be concerned."

Explanation

Question 13 of 14

1

You have a female patient admitted to the hospital with pericarditis due to an acute flare up of lupus. She also has kidney damage due to extensive renal involvement. She has been prescribed prednisone and cyclophosphamide to control her disease.

Select appropriate interventions for this patient.

Select one or more of the following:

Take vital signs every 4 hours.
Closely monitor CBC w/WBC differential, organ function studies, and electrolyte status.
Initiate protective isolation procedures.
Monitor I&O and take daily weights.
Assess the extremities for edema during each patient interaction.
Administer ibuprofen to treat arthritis.
Increase fluid intake.

Explanation

Question 14 of 14

1

You have a 20-year-old patient recently diagnosed with lupus. She is wondering how to avoid acute exasperation and painful dermatological manifestations of the disease. Which of the following interventions is not correct advice to give to the patient?

Select one of the following:

Avoid outdoor activities between 10:00 AM and 3:00 PM, if at all possible.
Sunscreen is not helpful in limiting sun exposure.
Keep your skin clean and dry by utilizing mild soaps on the skin.
Limit your usage of cosmetics
Avoid smoking, alcohol, and drugs.
Avoid utilizing estrogen-containing birth control pills.
Avoid fluorescent lighting, if possible.
Talk to your dentist about effective ways to maintain good oral hygiene.

	Created by Olivia McRitchie over 5 years ago

NCLEX Nursing (Medical-Surgical) Quiz on Exemplar 8.4: Systemic Lupus Erythematosus, created by Olivia McRitchie on 16/11/2018.

Exemplar 8.4: Systemic Lupus Erythematosus

Question 1 of 14

You have a young female nursing student just diagnosed with lupus. She's heard of this disorder, but knows very little about it and decides to ask you, the university nurse, about it. Which of the following statements made by the student nurse shows that teaching has been effective?

Select one of the following:

Explanation

Question 2 of 14

Select one of the following:

Explanation

Question 3 of 14

You are a nurse in a doctor's office about to see a male patient that has been taking procainamide for a little over a year. What questions might you ask this patient when he comes in?

Select one or more of the following:

Explanation

Question 4 of 14

Select the medications that have potential to cause drug-induced lupus.

Select one or more of the following:

Explanation

Question 5 of 14

Select one of the following:

Explanation

Question 6 of 14

Select one of the following:

Explanation

Question 7 of 14

Select one of the following:

Explanation

Question 8 of 14

You are concerned that the patient you are caring for might have systemic lupus erythematosus. Which tests might you order?

Select one or more of the following:

Explanation

Question 9 of 14

You have a patient presenting to the hospital with anasarca, with increased edema in the hands, feet, and face; fatigue; anorexia; and foamy urine. This patient has been diagnosed with lupus in the past. What tests might you order?

Select one or more of the following:

Explanation

Question 10 of 14

Which of the following instructions is important to give to a female patient taking hydroxychloroquine?

Select one of the following:

Explanation

Question 11 of 14

What are your responsibilities when taking care of a patient on IV azathioprine?

Select one or more of the following:

Explanation

Question 12 of 14

You have just taught a patient about precautions to take to prevent infection while taking cyclophosphamide. Which of the following statements made by the patient shows that teaching has been effective?

Select one of the following:

Explanation

Question 13 of 14

You have a female patient admitted to the hospital with pericarditis due to an acute flare up of lupus. She also has kidney damage due to extensive renal involvement. She has been prescribed prednisone and cyclophosphamide to control her disease. Select appropriate interventions for this patient.

Select one or more of the following:

Explanation

Question 14 of 14

You have a 20-year-old patient recently diagnosed with lupus. She is wondering how to avoid acute exasperation and painful dermatological manifestations of the disease. Which of the following interventions is not correct advice to give to the patient?

Select one of the following:

Explanation

You have a female patient admitted to the hospital with pericarditis due to an acute flare up of lupus. She also has kidney damage due to extensive renal involvement. She has been prescribed prednisone and cyclophosphamide to control her disease.

Select appropriate interventions for this patient.