Question 1

A nurse caring for a client with systemic lupus erythematous (SLE)who is prescribed immunosuppressive therapy.When providing teaching for this client,which topics are appropriate for the nurse to include? Select all that apply.
A) Avoid large crowds and situations that increase exposure to infection.
B) Report difficulty breathing or cough to the physician if taking cyclophosphamide.
C) Use aspirin instead of acetaminophen if fever develops.
D) Heavy menstrual bleeding may occur during therapy.
E) Maintain appropriate oral hydration.

Accepted Answer

A) When teaching a client with SLE who is receiving immunosuppressant therapy, the nurse will tell the client to avoiding large crowds and situations that increase 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, and aspirin should not be used, as this may increase the risk for bleeding. Women may have an absence of menstruation, not heavy bleeding, during therapy.
B) When teaching a client with SLE who is receiving immunosuppressant therapy, the nurse will tell the client to avoiding large crowds and situations that increase 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, and aspirin should not be used, as this may increase the risk for bleeding. Women may have an absence of menstruation, not heavy bleeding, during therapy.
C) When teaching a client with SLE who is receiving immunosuppressant therapy, the nurse will tell the client to avoiding large crowds and situations that increase 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, and aspirin should not be used, as this may increase the risk for bleeding. Women may have an absence of menstruation, not heavy bleeding, during therapy.
D) When teaching a client with SLE who is receiving immunosuppressant therapy, the nurse will tell the client to avoiding large crowds and situations that increase 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, and aspirin should not be used, as this may increase the risk for bleeding. Women may have an absence of menstruation, not heavy bleeding, during therapy.

Question 2

A nurse is caring for a client who is newly diagnosed with rheumatoid arthritis (RA).The client asks the nurse what the difference is between RA and osteoarthritis (OA).Which responses by the nurse are the most appropriate? Select all that apply.
A) "The onset of OA is gradual while the onset of RA may be rapid."
B) "With OA, multiple joints are symmetrically affected; RA affects one joint at a time."
C) "The affected joints in RA feel cold to the touch while the joints affected by OA are warm or hot to the touch."
D) "OA is slowly progressive while RA is characterized by exacerbations and remissions."
E) "The pain and stiffness with RA is with activity; OA pain and stiffness is predominant upon arising."

Accepted Answer

A) The onset of OA is gradual while the onset of RA may be rapid. RA affects multiple joints symmetrically while OA affects one joint at a time. The affected joints in OA feel cold to the touch while the joints affected by RA are warm or hot to the touch. OA is slowly progressive while RA has exacerbations and remissions. Pain associated with RA is predominant upon arising versus the pain in OA, which is with activity.
B) The onset of OA is gradual while the onset of RA may be rapid. RA affects multiple joints symmetrically while OA affects one joint at a time. The affected joints in OA feel cold to the touch while the joints affected by RA are warm or hot to the touch. OA is slowly progressive while RA has exacerbations and remissions. Pain associated with RA is predominant upon arising versus the pain in OA, which is with activity.
C) The onset of OA is gradual while the onset of RA may be rapid. RA affects multiple joints symmetrically while OA affects one joint at a time. The affected joints in OA feel cold to the touch while the joints affected by RA are warm or hot to the touch. OA is slowly progressive while RA has exacerbations and remissions. Pain associated with RA is predominant upon arising versus the pain in OA, which is with activity.
D) The onset of OA is gradual while the onset of RA may be rapid. RA affects multiple joints symmetrically while OA affects one joint at a time. The affected joints in OA feel cold to the touch while the joints affected by RA are warm or hot to the touch. OA is slowly progressive while RA has exacerbations and remissions. Pain associated with RA is predominant upon arising versus the pain in OA, which is with activity.
E) The onset of OA is gradual while the onset of RA may be rapid. RA affects multiple joints symmetrically while OA affects one joint at a time. The affected joints in OA feel cold to the touch while the joints affected by RA are warm or hot to the touch. OA is slowly progressive while RA has exacerbations and remissions. Pain associated with RA is predominant upon arising versus the pain in OA, which is with activity.

Question 3

A nurse is caring for a pregnant client who has rheumatoid arthritis (RA).Based on this data,which does the nurse anticipate when providing care to this client?
A) A higher risk for preterm delivery.
B) An increased need for medication.
C) An acute exacerbation of symptoms.
D) A continued risk for anemia.

Accepted Answer

A) The pregnant client with RA is at a continued risk for anemia. Many pregnant clients with RA may have prolonged gestations and often experience a remission during pregnancy and relapse after delivery. Due to remission, a decrease in medication is often necessitated.
B) The pregnant client with RA is at a continued risk for anemia. Many pregnant clients with RA may have prolonged gestations and often experience a remission during pregnancy and relapse after delivery. Due to remission, a decrease in medication is often necessitated.
C) The pregnant client with RA is at a continued risk for anemia. Many pregnant clients with RA may have prolonged gestations and often experience a remission during pregnancy and relapse after delivery. Due to remission, a decrease in medication is often necessitated.
D) The pregnant client with RA is at a continued risk for anemia. Many pregnant clients with RA may have prolonged gestations and often experience a remission during pregnancy and relapse after delivery. Due to remission, a decrease in medication is often necessitated.

Question 4

A nurse is caring for a client with systemic lupus erythematosus (SLE).The client begins to cry stating,"I am afraid I will be disfigured because of all of these lesions." Which interventions does the nurse plan to teach this client to minimize skin infections associated with SLE? Select all that apply.
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 10:00 a.m. and 3:00 p.m.
E) Decrease sun exposure between 3:00 p.m. and 5:00 p.m.

Accepted Answer

A) The nurse teaches the client to live a normal life with a few extra precautions. There is a relationship between sun exposure and infection, so the client is 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 or to decrease sun exposure between 3:00 p.m. and 5:00 p.m.
B) The nurse teaches the client to live a normal life with a few extra precautions. There is a relationship between sun exposure and infection, so the client is 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 or to decrease sun exposure between 3:00 p.m. and 5:00 p.m.
C) The nurse teaches the client to live a normal life with a few extra precautions. There is a relationship between sun exposure and infection, so the client is 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 or to decrease sun exposure between 3:00 p.m. and 5:00 p.m.
D) The nurse teaches the client to live a normal life with a few extra precautions. There is a relationship between sun exposure and infection, so the client is 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 or to decrease sun exposure between 3:00 p.m. and 5:00 p.m.
E) The nurse teaches the client to live a normal life with a few extra precautions. There is a relationship between sun exposure and infection, so the client is 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 or to decrease sun exposure between 3:00 p.m. and 5:00 p.m.

Question 5

The nurse is providing care for a newly married woman with systemic lupus erythematosus (SLE).Which client statement 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 the movies this weekend so that I get out of the house."
D) "I can take aspirin as indicated for pain."

Accepted Answer

A) Treatment for SLE can include cytotoxic drugs. The client is taught to avoid pregnancy by using contraceptives, as these drugs can cause birth defects. The client is taught to avoid crowds, as they are potential sources of infection. Client with SLE should contact their primary care providers should signs of infection occur, as the immune system is compromised. Aspirin can cause bleeding and should be taken with extreme care.
B) Treatment for SLE can include cytotoxic drugs. The client is taught to avoid pregnancy by using contraceptives, as these drugs can cause birth defects. The client is taught to avoid crowds, as they are potential sources of infection. Client with SLE should contact their primary care providers should signs of infection occur, as the immune system is compromised. Aspirin can cause bleeding and should be taken with extreme care.
C) Treatment for SLE can include cytotoxic drugs. The client is taught to avoid pregnancy by using contraceptives, as these drugs can cause birth defects. The client is taught to avoid crowds, as they are potential sources of infection. Client with SLE should contact their primary care providers should signs of infection occur, as the immune system is compromised. Aspirin can cause bleeding and should be taken with extreme care.
D) Treatment for SLE can include cytotoxic drugs. The client is taught to avoid pregnancy by using contraceptives, as these drugs can cause birth defects. The client is taught to avoid crowds, as they are potential sources of infection. Client with SLE should contact their primary care providers should signs of infection occur, as the immune system is compromised. Aspirin can cause bleeding and should be taken with extreme care.

Question 6

The nurse is caring for a client who is hospitalized due to an exacerbation of systemic lupus erythematosus (SLE).The nurse is reviewing the client's lab work and finds the white blood cell count (WBC)is shifted to the left.Based on this information,which 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 Integrity

Accepted Answer

A) All identified diagnoses are appropriate for a client with SLE. However, the shift to the left in the WBC count indicates an increased risk for infection. A shift to the left in a WBC differential is indicative of a large number of immature cells, suggesting infection. Therefore, the priority diagnosis is Risk for Infection.
B) All identified diagnoses are appropriate for a client with SLE. However, the shift to the left in the WBC count indicates an increased risk for infection. A shift to the left in a WBC differential is indicative of a large number of immature cells, suggesting infection. Therefore, the priority diagnosis is Risk for Infection.
C) All identified diagnoses are appropriate for a client with SLE. However, the shift to the left in the WBC count indicates an increased risk for infection. A shift to the left in a WBC differential is indicative of a large number of immature cells, suggesting infection. Therefore, the priority diagnosis is Risk for Infection.
D) All identified diagnoses are appropriate for a client with SLE. However, the shift to the left in the WBC count indicates an increased risk for infection. A shift to the left in a WBC differential is indicative of a large number of immature cells, suggesting infection. Therefore, the priority diagnosis is Risk for Infection.

Question 7

A client asks the nurse if there are any conditions that can exacerbate systemic lupus erythematosus (SLE).Which response by the nurse is the most appropriate?
A) "Conditions that cause hypotension can often exacerbate SLE."
B) "GI upset is often associated with SLE exacerbation."
C) "Pregnancy is often associated with an SLE exacerbation."
D) "Fever is a known trigger for an SLE exacerbation."

Accepted Answer

A) Pregnancy can be associated with an exacerbation of SLE due to the rise of estrogen levels. Hypotension, fever, and GI upset are not factors that risk exacerbation of SLE.
B) Pregnancy can be associated with an exacerbation of SLE due to the rise of estrogen levels. Hypotension, fever, and GI upset are not factors that risk exacerbation of SLE.
C) Pregnancy can be associated with an exacerbation of SLE due to the rise of estrogen levels. Hypotension, fever, and GI upset are not factors that risk exacerbation of SLE.
D) Pregnancy can be associated with an exacerbation of SLE due to the rise of estrogen levels. Hypotension, fever, and GI upset are not factors that risk exacerbation of SLE.

Question 8

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

Accepted Answer

A) The rash over the nose and cheeks is sometimes called a butterfly rash and is classic for the diagnosis of systemic lupus erythematosus (SLE). While fibromyalgia, Lyme's disease, and gout share some symptoms of SLE, they do not cause a rash over the nose and cheeks.
B) The rash over the nose and cheeks is sometimes called a butterfly rash and is classic for the diagnosis of systemic lupus erythematosus (SLE). While fibromyalgia, Lyme's disease, and gout share some symptoms of SLE, they do not cause a rash over the nose and cheeks.
C) The rash over the nose and cheeks is sometimes called a butterfly rash and is classic for the diagnosis of systemic lupus erythematosus (SLE). While fibromyalgia, Lyme's disease, and gout share some symptoms of SLE, they do not cause a rash over the nose and cheeks.
D) The rash over the nose and cheeks is sometimes called a butterfly rash and is classic for the diagnosis of systemic lupus erythematosus (SLE). While fibromyalgia, Lyme's disease, and gout share some symptoms of SLE, they do not cause a rash over the nose and cheeks.

Question 9

The nurse is providing health education to a diverse group at a neighborhood community center.Why does the nurse plan to include signs and symptoms of systemic lupus erythematosus (SLE)?
A) The neighborhood is composed of many young female children.
B) The audience has asked the nurse to include the information.
C) The audience is mainly composed of Caucasian women.
D) The audience is mainly females of Asian-American descent.

Accepted Answer

A) Among women who are of child-bearing age, SLE is seen in more African-Americans, Hispanics, and Asian-Americans than Caucasians. There is no evidence that the audience asked for the information.
B) Among women who are of child-bearing age, SLE is seen in more African-Americans, Hispanics, and Asian-Americans than Caucasians. There is no evidence that the audience asked for the information.
C) Among women who are of child-bearing age, SLE is seen in more African-Americans, Hispanics, and Asian-Americans than Caucasians. There is no evidence that the audience asked for the information.
D) Among women who are of child-bearing age, SLE is seen in more African-Americans, Hispanics, and Asian-Americans than Caucasians. There is no evidence that the audience asked for the information.

Question 10

A client with systemic lupus erythematosus (SLE)is being treated with immunosuppressant drugs and corticosteroids.When providing teaching for this client,which topics are appropriate for the nurse to include? Select all that apply.
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 signs of infection to the healthcare provider.

Accepted Answer

A) Crowds may increase exposure to infection. Annual influenza vaccination is recommended but clients with significant immunosuppression should not receive live vaccines. Immunosuppressive drugs may increase the risk of birth defects. Aspirin products may increase the risk of bleeding. Chills, fever, sore throat, fatigue, or malaise should be reported.
B) Crowds may increase exposure to infection. Annual influenza vaccination is recommended but clients with significant immunosuppression should not receive live vaccines. Immunosuppressive drugs may increase the risk of birth defects. Aspirin products may increase the risk of bleeding. Chills, fever, sore throat, fatigue, or malaise should be reported.
C) Crowds may increase exposure to infection. Annual influenza vaccination is recommended but clients with significant immunosuppression should not receive live vaccines. Immunosuppressive drugs may increase the risk of birth defects. Aspirin products may increase the risk of bleeding. Chills, fever, sore throat, fatigue, or malaise should be reported.
D) Crowds may increase exposure to infection. Annual influenza vaccination is recommended but clients with significant immunosuppression should not receive live vaccines. Immunosuppressive drugs may increase the risk of birth defects. Aspirin products may increase the risk of bleeding. Chills, fever, sore throat, fatigue, or malaise should be reported.
E) Crowds may increase exposure to infection. Annual influenza vaccination is recommended but clients with significant immunosuppression should not receive live vaccines. Immunosuppressive drugs may increase the risk of birth defects. Aspirin products may increase the risk of bleeding. Chills, fever, sore throat, fatigue, or malaise should be reported.

Question 11

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

Accepted Answer

A) 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.
B) 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.
C) 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.
D) 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.

Question 12

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

Accepted Answer

A) Hydroxychloroquine (Plaquenil) is an antimalarial drug used in SLE 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.
B) Hydroxychloroquine (Plaquenil) is an antimalarial drug used in SLE 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.
C) Hydroxychloroquine (Plaquenil) is an antimalarial drug used in SLE 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.
D) Hydroxychloroquine (Plaquenil) is an antimalarial drug used in SLE 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.

Question 13

The nurse is caring for a client diagnosed with discoid lupus erythematosus.The nurse is collaborating with the client to set goals for the nursing plan of care.Which is an appropriate goal for this client?
A) Work through the stages of death and dying.
B) Compliance with a sun protection plan.
C) Gain weight to within 10 pounds of normal for height.
D) Report pain no higher than 4 on a scale of 1-10.

Accepted Answer

A) 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.
B) 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.
C) 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.
D) 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.

Quiz 8: Immunity

A nurse caring for a client with systemic lupus erythematous (SLE) who is prescribed immunosuppressive therapy.When providing teaching for this client,which topics are appropriate for the nurse to include? Select all that apply.

A nurse is caring for a client who is newly diagnosed with rheumatoid arthritis (RA) .The client asks the nurse what the difference is between RA and osteoarthritis (OA) .Which responses by the nurse are the most appropriate? Select all that apply.

A nurse is caring for a pregnant client who has rheumatoid arthritis (RA) .Based on this data,which does the nurse anticipate when providing care to this client?

The nurse is providing care for a newly married woman with systemic lupus erythematosus (SLE) .Which client statement indicates an appropriate understanding of the plan of care?

A client asks the nurse if there are any conditions that can exacerbate systemic lupus erythematosus (SLE) .Which response by the nurse is the most appropriate?

The nurse is providing health education to a diverse group at a neighborhood community center.Why does the nurse plan to include signs and symptoms of systemic lupus erythematosus (SLE) ?

A client with systemic lupus erythematosus (SLE) is being treated with immunosuppressant drugs and corticosteroids.When providing teaching for this client,which topics are appropriate for the nurse to include? Select all that apply.

The nurse is planning care for an adolescent client who has systemic lupus erythematosus (SLE) .Which action by the client indicates the implemented plan of care is appropriate?

A nurse is caring for a client with systemic lupus erythematous (SLE) who is taking hydroxychloroquine (Plaquenil) .When providing care for this client,the nurse monitors for which adverse effects associated with the prescribed medication?

The nurse is caring for a client diagnosed with discoid lupus erythematosus.The nurse is collaborating with the client to set goals for the nursing plan of care.Which is an appropriate goal for this client?