1. A 26-year-old woman has been diagnosed with early systemic lupus erythematosus (SLE) involving her joints. In
teaching the patient about the disease, the nurse includes the information that SLE is a(n):
A. Hereditary disorder of women but usually does not show clinical symptoms unless a woman becomes pregnant.
B. Autoimmune disease of women in which antibodies are formed that destroy all nucleated cells in the body.
C. Disorder of immune function, but it is extremely variable in its course, and there is no way to predict its progression.
D. Disease that causes production of antibodies that bind with cellular estrogen receptors, causing an inflammatory
response.
1. Answer: C
Rationale: SLE has an unpredictable course, even with appropriate treatment. Women are more at risk for SLE, but it is not confined exclusively to
women. Clinical symptoms may worsen during pregnancy but are not confined to pregnancy or the perinatal period. All nucleated cells are not destroyed
by the antinuclear antibodies. The inflammation in SLE is not caused by antibody binding to cellular estrogen receptors.
2. A patient with an acute exacerbation of systemic lupus erythematosus (SLE) is hospitalized with incapacitating fatigue,
acute hand and wrist pain, and proteinuria. The health care provider prescribes prednisone (Deltasone) 40 mg twice daily.
Which nursing action should be included in the plan of care?
A. Institute seizure precautions.
B. Reorient to time and place PRN.
C. Monitor intake and output.
D. Place on cardiac monitor.
2. Answer: C
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.
3. A patient with systemic lupus erythematosus (SLE) who has a facial rash and alopecia tells the nurse, "I hate the way I
look! I never go anyplace except here to the health clinic." An appropriate nursing diagnosis for the patient is:
A. Activity intolerance related to fatigue and inactivity.
B. Impaired skin integrity related to itching and skin sloughing.
C. Social isolation related to embarrassment about the effects of SLE.
D. Impaired social interaction related to lack of social skills.
3. Answer: C
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 nonpruritic. There is no evidence of lack of social skills for this patient.
4. 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 specific for SLE is the presence of:
A. Rheumatoid factor.
B. Anti-Smith antibody (Anti-Sm).
C. Antinuclear antibody (ANA).
D. Lupus erythematosus (LE) cell prep.
4. Answer: B
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.
, 5. Following instruction for a patient with newly diagnosed systemic lupus erythematosus (SLE), the nurse determines that
teaching about the disease has been effective when the patient says:
A. "I should expect to have a low fever all the time with this disease."
B. "I need to restrict my exposure to sunlight to prevent an acute onset of symptoms."
C. "I should try to ignore my symptoms as much as possible and have a positive outlook."
D. "I can expect a temporary improvement in my symptoms if I become pregnant."
5. Answer: B
Rationale: Sun exposure is associated with SLE exacerbation, and patients should use sunscreen with an SPF of at least 15 and stay out of the sun
between 11:00 AM and 3:00 PM. Low-grade fever may occur with an exacerbation but should not be expected all the time. A positive attitude may
decrease the incidence of SLE exacerbations, but patients are taught to self-monitor for symptoms that might indicate changes in the disease process.
Symptoms may worsen during pregnancy and especially during the postpartum period.
6. A 19-year-old patient who is taking azathioprine (Imuran) for systemic lupus erythematosus has a check-up before
leaving home for college. The health care provider writes all of these orders. Which one should the nurse question?
A. Naproxen (Aleve) 200 mg BID
B. Give measles-mumps-rubella (MMR) immunization
C. Draw anti-DNA titer
D. Famotidine (Pepcid) 20 mg daily
6. Answer: B
Rationale: Live virus vaccines, such as rubella, are contraindicated in a patient taking immunosuppressive drugs. The other orders are appropriate for the
patient.
7. A client is suspected of having systemic lupus erythematous. The nurse monitors the client, knowing that which of the
following is one of the initial characteristic sign of systemic lupus erythematous?
A. Weight gain
B. Subnormal temperature
C. Elevated red blood cell count
D. Rash on the face across the bridge of the nose
7. Answer: D
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.
teaching the patient about the disease, the nurse includes the information that SLE is a(n):
A. Hereditary disorder of women but usually does not show clinical symptoms unless a woman becomes pregnant.
B. Autoimmune disease of women in which antibodies are formed that destroy all nucleated cells in the body.
C. Disorder of immune function, but it is extremely variable in its course, and there is no way to predict its progression.
D. Disease that causes production of antibodies that bind with cellular estrogen receptors, causing an inflammatory
response.
1. Answer: C
Rationale: SLE has an unpredictable course, even with appropriate treatment. Women are more at risk for SLE, but it is not confined exclusively to
women. Clinical symptoms may worsen during pregnancy but are not confined to pregnancy or the perinatal period. All nucleated cells are not destroyed
by the antinuclear antibodies. The inflammation in SLE is not caused by antibody binding to cellular estrogen receptors.
2. A patient with an acute exacerbation of systemic lupus erythematosus (SLE) is hospitalized with incapacitating fatigue,
acute hand and wrist pain, and proteinuria. The health care provider prescribes prednisone (Deltasone) 40 mg twice daily.
Which nursing action should be included in the plan of care?
A. Institute seizure precautions.
B. Reorient to time and place PRN.
C. Monitor intake and output.
D. Place on cardiac monitor.
2. Answer: C
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.
3. A patient with systemic lupus erythematosus (SLE) who has a facial rash and alopecia tells the nurse, "I hate the way I
look! I never go anyplace except here to the health clinic." An appropriate nursing diagnosis for the patient is:
A. Activity intolerance related to fatigue and inactivity.
B. Impaired skin integrity related to itching and skin sloughing.
C. Social isolation related to embarrassment about the effects of SLE.
D. Impaired social interaction related to lack of social skills.
3. Answer: C
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 nonpruritic. There is no evidence of lack of social skills for this patient.
4. 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 specific for SLE is the presence of:
A. Rheumatoid factor.
B. Anti-Smith antibody (Anti-Sm).
C. Antinuclear antibody (ANA).
D. Lupus erythematosus (LE) cell prep.
4. Answer: B
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.
, 5. Following instruction for a patient with newly diagnosed systemic lupus erythematosus (SLE), the nurse determines that
teaching about the disease has been effective when the patient says:
A. "I should expect to have a low fever all the time with this disease."
B. "I need to restrict my exposure to sunlight to prevent an acute onset of symptoms."
C. "I should try to ignore my symptoms as much as possible and have a positive outlook."
D. "I can expect a temporary improvement in my symptoms if I become pregnant."
5. Answer: B
Rationale: Sun exposure is associated with SLE exacerbation, and patients should use sunscreen with an SPF of at least 15 and stay out of the sun
between 11:00 AM and 3:00 PM. Low-grade fever may occur with an exacerbation but should not be expected all the time. A positive attitude may
decrease the incidence of SLE exacerbations, but patients are taught to self-monitor for symptoms that might indicate changes in the disease process.
Symptoms may worsen during pregnancy and especially during the postpartum period.
6. A 19-year-old patient who is taking azathioprine (Imuran) for systemic lupus erythematosus has a check-up before
leaving home for college. The health care provider writes all of these orders. Which one should the nurse question?
A. Naproxen (Aleve) 200 mg BID
B. Give measles-mumps-rubella (MMR) immunization
C. Draw anti-DNA titer
D. Famotidine (Pepcid) 20 mg daily
6. Answer: B
Rationale: Live virus vaccines, such as rubella, are contraindicated in a patient taking immunosuppressive drugs. The other orders are appropriate for the
patient.
7. A client is suspected of having systemic lupus erythematous. The nurse monitors the client, knowing that which of the
following is one of the initial characteristic sign of systemic lupus erythematous?
A. Weight gain
B. Subnormal temperature
C. Elevated red blood cell count
D. Rash on the face across the bridge of the nose
7. Answer: D
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.
