Chapter 69: SLE Flashcards

Question

A patient with systemic lupus erythematosus (SLE) presents with a red, ring-shaped lesion on their back. The lesion does not scar or itch, and it is not thick and scaly. What type of lupus is this patient most likely experiencing? a. Subacute cutaneous lupus erythematosus (SCLE) b. Chronic cutaneous lupus erythematosus (CCLE) c. Acute cutaneous lupus erythematosus d. Drug-induced lupus erythematosus

Answer 1

a. Subacute cutaneous lupus erythematosus (SCLE) Rationale: SCLE is characterized by red, ring-shaped lesions that do not scar or itch and are not thick and scaly. These features match the description provided for the patient.

Answer 2

a. Malar rash b. Alopecia c. Oral ulcers Rationale: Common skin manifestations in SLE include the malar rash (butterfly rash), alopecia, and oral ulcers. Thick, scaly lesions are not typical of SLE.

Answer 3

b. 10% Rationale: About 10% of patients with CCLE later develop lupus in other organ systems.

Answer 4

b. "Hair loss can occur in SLE, but it may grow back during remission." Rationale: Alopecia is common in SLE, and hair may grow back during remission. However, hair loss may be permanent over lesions.

Answer 5

c. Butterfly rash over the cheeks and bridge of the nose Rationale: The most common form of acute cutaneous lupus erythematosus is the butterfly rash (malar rash) over the cheeks and bridge of the nose, which looks like a sunburn.

Answer 6

a. Sun exposure c. Stress d. Penicillin use Rationale: Severe skin reactions in SLE can be triggered by sun exposure, stress, and the use of certain drugs such as penicillin. Genetic predisposition, while a contributing factor to SLE in general, is not specifically linked to severe skin reactions.

Answer 7

b. Chronic cutaneous lupus erythematosus (CCLE) Rationale: The symptoms of a dry, scaly, and atrophied scalp along with hair loss are consistent with chronic cutaneous lupus erythematosus (CCLE).

Answer 8

b. Pain in multiple joints with morning stiffness Rationale: Pain in multiple joints (polyarthralgia) with morning stiffness is often the first symptom of arthritis in patients with SLE. This symptom may precede the onset of multisystem disease by many years.

Answer 9

a. Swan neck deformity of the fingers b. Ulnar deviation c. Subluxation with joint laxity Rationale: Common deformities associated with SLE-related arthritis include swan neck deformity of the fingers, ulnar deviation, and subluxation with joint laxity. Kyphosis is not typically associated with SLE-related arthritis.

Answer 10

b. Nonerosive arthritis Rationale: SLE-related arthritis is often nonerosive, meaning it does not cause erosion of the bone. This distinguishes it from other types of arthritis like rheumatoid arthritis, which is erosive.

Answer 11

a. Bone loss and fracture Rationale: Patients with SLE have an increased risk for bone loss and fracture due to the chronic inflammation and possible use of corticosteroids in their treatment regimen.

Answer 12

c. Polyarthralgia Rationale: Polyarthralgia, or pain in multiple joints, is a common early symptom of musculoskeletal problems in patients with SLE. It often presents with morning stiffness and may precede other multisystem symptoms.

Answer 13

c. SLE-related arthritis Rationale: The deformities described, including the swan neck appearance of the fingers, are characteristic of SLE-related arthritis. These deformities occur due to joint and muscle pain, stiffness, and nonerosive arthritis associated with SLE.

Answer 14

b. Tachypnea and cough Rationale: Tachypnea (rapid breathing) and cough suggest the presence of lung disease in patients with SLE. These symptoms indicate possible involvement of the respiratory system.

Answer 15

a. Dysrhythmias Rationale: Fibrosis of the sinoatrial and atrioventricular nodes in patients with SLE can lead to dysrhythmias. Dysrhythmias are indicative of abnormal heart rhythms and can be a sign of advanced disease.

Answer 16

a. Pericarditis Rationale: Inflammation of the heart lining is referred to as pericarditis, which can cause chest pain and other symptoms. It is one of the possible cardiac complications in patients with SLE.

Answer 17

c. Dysrhythmias due to fibrosis of the sinoatrial and atrioventricular nodes Rationale: Dysrhythmias due to fibrosis of the sinoatrial and atrioventricular nodes show advanced disease and are a leading cause of death among patients with SLE.

Answer 18

c. Hypertension and hypercholesterolemia Rationale: Hypertension and hypercholesterolemia from steroid use need aggressive treatment and careful monitoring in patients with SLE. These complications can increase the risk of cardiovascular disease.

Answer 19

a. Stroke b. Gangrene c. Heart attack Rationale: Secondary antiphospholipid syndrome (APS) is a coagulation disorder that causes clots in the arteries and veins, increasing the risk for stroke, gangrene, and heart attack.

Answer 20

c. Increased risk for cardiovascular disease Rationale: Hypertension and hypercholesterolemia in patients with SLE increase the risk for cardiovascular disease, making it important to manage these conditions aggressively and monitor the patient closely.

Answer 21

c. Prepare the patient for a possible renal biopsy Rationale: In SLE, renal involvement can manifest as lupus nephritis, which varies in severity from mild proteinuria to rapidly progressive glomerulonephritis. A renal biopsy helps determine the extent of renal damage and guides treatment. While fluid and dietary management may be important, they do not replace the need for a definitive diagnosis through biopsy. Immunosuppressive therapy is crucial in slowing disease progression and should not be discontinued abruptly.

Answer 22

c. “I may begin to feel better within a few days of starting the medication.” Rationale: Belimumab (Benlysta) is a human monoclonal antibody that reduces autoantibody levels and controls disease activity in lupus nephritis. However, it takes weeks to months for the full therapeutic effects to become evident. Patients should avoid live vaccines due to immunosuppression and be vigilant about infections, as the medication increases the risk of opportunistic infections.

Answer 23

d. Ibuprofen Rationale: NSAIDs like ibuprofen can worsen renal function in patients with lupus nephritis by reducing renal blood flow and contributing to nephrotoxicity. Immunosuppressive agents such as azathioprine, voclosporin, and corticosteroids like prednisone are commonly used to manage lupus nephritis and preserve renal function.

Answer 24

a. To provide immediate immunosuppression to reduce renal inflammation Rationale: High-dose IV methylprednisolone is often used in lupus nephritis to rapidly reduce inflammation and immune-mediated damage in the kidneys. It is particularly beneficial in severe cases or when cytotoxic agents have not yet taken effect. It does not directly enhance renal perfusion or prevent osteoporosis.

Answer 25

b. Blood pressure of 150/90 mmHg Rationale: Voclosporin is a calcineurin inhibitor that can cause hypertension. Uncontrolled hypertension can accelerate renal damage in lupus nephritis, making it a priority concern. While hyperglycemia is a possible side effect, the blood glucose level provided is not immediately critical. The potassium and WBC levels are within normal limits.

Answer 26

b. “They help reduce your immune system’s attack on your kidneys.” Rationale: In lupus nephritis, the immune system mistakenly attacks kidney tissue, leading to inflammation and damage. Immunosuppressive agents slow this process and help preserve kidney function. They do not directly prevent infections, increase urine output, or reverse kidney damage.

Answer 27

a. “I should take this medication with food to decrease nausea.” Rationale: Azathioprine can cause gastrointestinal discomfort, so taking it with food may help. It should not be discontinued abruptly, fluid intake should not be restricted unless directed by a provider, and it does not fully reverse kidney damage.

Answer 28

d. Urine output of 100 mL in 12 hours Rationale: Oliguria (low urine output) is a key indicator of worsening renal function and possible ESRD. A creatinine level of 1.2 mg/dL and normal hemoglobin and BP levels are not immediately concerning in this context.

Answer 29

c. “I will stop taking my prednisone if I feel better to avoid side effects.” Rationale: Abruptly stopping corticosteroids can lead to adrenal insufficiency and a lupus flare. Patients must taper the dose under medical supervision.

Answer 30

b. “With proper treatment, progression to end-stage renal disease can often be slowed or prevented.” Rationale: While lupus nephritis can lead to ESRD, early and aggressive treatment can slow its progression. Immediate dialysis is not required in most cases, and complete reversal of damage is not guaranteed.

Answer 31

c. An inflammatory process affecting the central nervous system Rationale: Diffuse neuropsychiatric SLE (NPSLE) is caused by an inflammatory process in the central nervous system and can result in acute confusion, psychosis, anxiety, depression, or cognitive impairment. While stress can contribute to symptoms, this presentation suggests an organic cause rather than psychological distress alone. Focal NPSLE, often associated with antiphospholipid antibodies, typically leads to strokes or focal deficits rather than widespread cognitive symptoms.

Answer 32

b. Cerebrovascular accident (CVA) Rationale: Patients with SLE, particularly those with antiphospholipid antibodies, are at increased risk for cerebrovascular events due to clot formation. New-onset severe headache and speech difficulties may indicate an ischemic stroke, requiring immediate assessment and intervention. While aseptic meningitis can occur, it is more likely to present with fever and neck stiffness rather than focal deficits.

Answer 33

a. Positive antiphospholipid antibodies Rationale: Antiphospholipid antibodies are often associated with focal NPSLE but can also contribute to diffuse neurological symptoms. Diffuse NPSLE is an inflammatory process that can cause cognitive dysfunction, anxiety, and depression. ESR is typically elevated in active SLE, and kidney function tests (creatinine/BUN) are relevant for lupus nephritis rather than neurological involvement.

Answer 34

d. A disease flare causing an increase in headache severity Rationale: Headaches are common in SLE and often become severe during disease flares. The absence of infection-related symptoms makes bacterial meningitis unlikely. While corticosteroids can cause headaches, they are less likely to explain a worsening headache over a week. Intracranial hemorrhage is possible but less common than inflammatory headache exacerbation.

Answer 35

a. Fever, neck stiffness, and photophobia Rationale: Aseptic meningitis in SLE presents similarly to bacterial meningitis, with fever, neck stiffness, photophobia, and headache, but without an identifiable infectious organism. Muscle weakness and ptosis suggest myasthenia gravis, while hemiparesis and facial drooping are more indicative of stroke.

Answer 36

a. Monitoring for signs of stroke or transient ischemic attack Rationale: Focal NPSLE is caused by thrombotic events in the presence of antiphospholipid antibodies, increasing the risk of stroke. Prompt recognition of signs like unilateral weakness, slurred speech, or vision changes is critical. While cognitive impairment and psychiatric symptoms can occur in lupus, they are more related to diffuse NPSLE rather than focal NPSLE.

Answer 37

a. Decreased risk of thrombosis Rationale: Hydroxychloroquine has been shown to reduce the risk of clot formation in patients with SLE, particularly those with antiphospholipid antibodies. It does not directly increase hemoglobin, prevent leukopenia, or enhance platelet production, but it plays a crucial role in decreasing the risk of thrombotic events.

Answer 38

b. Bruising and petechiae Rationale: A platelet count of 45,000/mm³ indicates thrombocytopenia, putting the patient at risk for spontaneous bleeding. Bruising and petechiae suggest increased capillary fragility and potential internal bleeding, requiring immediate evaluation. While anemia-related fatigue and mild gingival bleeding can occur, the risk of significant bleeding complications is more urgent.

Answer 39

c. Autoimmune destruction of blood cells Rationale: SLE causes hematologic abnormalities due to antibody formation against blood cells, leading to anemia (low hemoglobin) and leukopenia (low WBC count). Thrombocytopenia is also common but not present in this case. While immunosuppressive drugs can cause bone marrow suppression, the autoimmune nature of SLE makes it the more likely cause.

Answer 40

d. Monitor for signs of deep vein thrombosis or stroke Rationale: Patients with lupus and antiphospholipid syndrome are at high risk for clotting disorders, and aspirin resistance increases this risk. The nurse should prioritize monitoring for signs of thrombosis, such as unilateral leg swelling or neurological deficits. While gastrointestinal bleeding is a concern with aspirin, the immediate threat is clot formation rather than excessive bleeding.

Answer 41

d. “I plan to get the measles, mumps, and rubella (MMR) vaccine at my next visit.” Rationale: Live virus vaccines, such as MMR, are contraindicated in patients receiving corticosteroids or cytotoxic drugs due to the risk of infection. The flu vaccine is safe, and infection prevention strategies (handwashing, avoiding sick contacts) are important for immunosuppressed patients. The recombinant (non-live) shingles vaccine is recommended, but the live version (Zostavax) should be avoided.

Answer 42

b. Obtain a sputum culture and prepare for a chest X-ray Rationale: Pneumonia is the most common infection in patients with SLE, and immunosuppressive therapy increases the risk of serious bacterial infections. A sputum culture and chest X-ray are essential to confirm pneumonia and guide treatment. Rest and fluids may help, but diagnostic testing is the priority. Administering acetaminophen may mask symptoms without addressing the underlying infection.

Answer 43

c. “This vaccine will help lower my risk of getting pneumonia.” Rationale: Pneumonia is the most common infection in SLE, and vaccination is an important preventive measure. Inactivated vaccines, including the pneumococcal and flu vaccines, are safe and recommended for immunosuppressed patients. Live vaccines should be avoided, but inactivated vaccines are necessary to reduce infection risk.

Answer 44

c. “If I feel better, I can stop taking my medication without consulting my doctor.” Rationale: Abruptly stopping immunosuppressive therapy can lead to lupus flares and worsen disease progression. Patients must understand that these medications require consistent use and should only be adjusted under medical supervision. The other statements reflect appropriate knowledge about infection prevention and medication monitoring.

Answer 45

d. New onset of fever and purulent wound drainage Rationale: Patients on corticosteroids are at high risk for infection due to immunosuppression. A new fever and purulent drainage suggest an active infection that requires immediate intervention. Elevated blood glucose and Cushingoid features (moon face, fat redistribution) are expected side effects but are not emergencies. Mild bruising is also common due to steroid-induced skin thinning.

Answer 46

d. Presence of anti-Smith (Sm) antibodies Rationale: While ANA is present in 97% of SLE patients, it is not specific to SLE. Anti-Smith (Sm) antibodies are highly specific for SLE and strongly support the diagnosis. ESR and CRP are markers of inflammation but are not diagnostic for SLE.

Answer 47

b. Anti-double-stranded DNA antibodies Rationale: Anti-dsDNA antibodies are more specific to SLE than ANA and help confirm the diagnosis. RF is associated with rheumatoid arthritis, D-dimer is used for clotting disorders, and hemoglobin A1c monitors blood glucose levels.

Answer 48

c. Suggests active inflammation Rationale: ESR is a nonspecific marker of inflammation and is used to monitor disease activity in SLE. It does not diagnose SLE, indicate renal function, or confirm antiphospholipid syndrome.

Answer 49

b. Increased C-reactive protein (CRP) Rationale: CRP is an inflammatory marker that increases during disease flares and is used to monitor lupus activity. Anti-Smith antibodies do not fluctuate significantly, ANA remains positive but is not useful for monitoring, and platelet counts often decrease due to lupus-related thrombocytopenia.

Answer 50

a. Increased risk of thrombosis Rationale: Antiphospholipid antibodies are associated with clot formation, leading to an increased risk of deep vein thrombosis, stroke, or pulmonary embolism. They do not directly affect infection risk, immune response, or joint pain.

Answer 51

b. “My doctor will monitor my ESR and CRP to track my disease activity.” Rationale: ESR and CRP are used to monitor inflammation and disease activity in SLE. A positive ANA alone does not confirm lupus, anti-Smith antibodies do not disappear with remission, and SLE is diagnosed based on multiple criteria, not a single test.

Answer 52

a. Positive ANA, elevated ESR, presence of anti-Smith antibodies Rationale: A positive ANA is present in most SLE patients, ESR elevation indicates active inflammation, and anti-Smith antibodies are highly specific for SLE. Negative ANA and the presence of rheumatoid factor suggest rheumatoid arthritis, and normal inflammatory markers make active SLE unlikely.

Answer 53

b. “With early diagnosis and proper treatment, you can live a long and healthy life.” Rationale: While SLE is a chronic disease, early intervention and treatment can significantly improve quality of life and survival. Avoiding medication can lead to disease flares, and regular follow-ups are necessary to monitor for complications.

Answer 54

d. Assessing for organ involvement and disease severity Rationale: Since SLE can affect multiple organs, early detection of complications is essential to improve prognosis. Monitoring only joint pain and fatigue ignores other systemic effects. Medication adherence and routine follow-up visits are critical for disease management.

Answer 55

c. “Since I am young, my lupus will not cause any severe complications.” Rationale: SLE can cause severe complications regardless of age, including organ damage. Early diagnosis, social determinants of health, and ongoing monitoring all influence disease outcomes.

Answer 56

b. Increased risk of infection Rationale: Corticosteroids suppress the immune system, increasing the risk of infections. They are more commonly associated with hyperglycemia rather than hypoglycemia, hypokalemia rather than hyperkalemia, and do not directly cause increased platelet aggregation.

Answer 57

d. Early diagnosis, routine assessment, and prompt intervention Rationale: A comprehensive approach that includes early detection, frequent monitoring, and immediate treatment of organ involvement improves survival. NSAIDs alone are not sufficient for severe SLE, and immunosuppressants are necessary despite side effects. Stopping medications during remission can lead to disease flares.

Answer 58

b. Dark, tarry stools Rationale: Dark, tarry stools indicate gastrointestinal (GI) bleeding, a serious adverse effect of NSAIDs. Long-term NSAID use increases the risk of peptic ulcers and GI bleeding, requiring close monitoring.

Answer 59

a. “I need to have an eye exam every 6 to 12 months.” Rationale: Hydroxychloroquine can cause retinopathy over time, requiring regular ophthalmologic exams. It does not cause significant immunosuppression, doses should not be doubled, and stopping it abruptly can lead to disease flares.

Answer 60

c. “Taper the dose gradually rather than stopping abruptly.” Rationale: Corticosteroids must be tapered slowly to prevent adrenal insufficiency. Stopping them suddenly can cause life-threatening complications.

Answer 61

a. Increased risk of infection Rationale: Corticosteroids suppress the immune system, increasing the risk of infections. Patients should be monitored for signs of infection, and live vaccines should be avoided.

Answer 62

c. International normalized ratio (INR) Rationale: INR is monitored in patients on warfarin to assess clotting risk. A therapeutic INR reduces the likelihood of clot formation in SLE patients prone to hypercoagulability.

Answer 63

a. Peripheral neuropathy Rationale: Dapsone, an antileprosy drug, is used when hydroxychloroquine is not tolerated. A known side effect is peripheral neuropathy, requiring close monitoring.

Answer 64

b. Tacrolimus Rationale: Tacrolimus is a topical immunomodulator that suppresses immune activity in the skin and is used for treating severe skin lesions when corticosteroids are ineffective.

Answer 65

d. Complete blood count (CBC) Rationale: Cyclophosphamide is an immunosuppressive drug that can cause bone marrow suppression, leading to leukopenia, anemia, and thrombocytopenia. Monitoring CBC is essential to detect complications early.

Answer 66

d. “They help us monitor your disease activity and treatment effectiveness.” Rationale: Serial anti-DNA titers and serum complement levels indicate disease activity. Elevated anti-DNA titers suggest worsening disease, while low complement levels indicate immune complex formation.

Answer 67

c. “Report any signs of infection immediately.” Rationale: Azathioprine is an immunosuppressant that increases the risk of infections. Patients must be educated on recognizing and reporting early signs of infection.

Answer 68

a. History of gastritis Rationale: NSAIDs can cause GI irritation and worsen conditions like gastritis, increasing the risk of ulcers and bleeding. Alternative pain management strategies should be considered.

Answer 69

c. Live-attenuated influenza vaccine Rationale: Patients receiving corticosteroids or immunosuppressants should avoid live vaccines due to the risk of infection.

Answer 70

b. “Use sunscreen when outdoors.” Rationale: Pimecrolimus is a topical immunomodulator that increases photosensitivity, requiring sun protection.

Answer 71

d. Preserve renal function Rationale: Mycophenolate mofetil is an immunosuppressant used to prevent renal damage in lupus nephritis, helping to slow disease progression and maintain kidney function.

Answer 72

c. New-onset fever and worsening joint inflammation Rationale: Disease flares in SLE often present with fever, increased joint inflammation, and worsening fatigue. ESR and CRP levels would typically be elevated, and kidney involvement may lead to fluid retention rather than increased urine output.

Answer 73

c. Dark, tarry stools Rationale: Tarry stools indicate GI bleeding, a serious adverse effect of corticosteroids. While mild bruising, edema, and increased appetite are expected side effects, GI bleeding requires immediate medical attention.

Answer 74

a. Weight gain of 5 lbs in 1 week Rationale: Rapid weight gain suggests fluid retention, a common side effect of corticosteroids that can lead to complications such as hypertension and renal impairment.

Answer 75

b. Assess for peripheral neuropathy Rationale: Peripheral neuropathy, a complication of SLE, can cause numbness, tingling, and weakness in the extremities. It must be assessed to prevent worsening nerve damage.

Answer 76

d. Personality changes and confusion Rationale: Personality changes and confusion may indicate CNS involvement of SLE or corticosteroid-induced psychosis, both of which require urgent intervention.

Answer 77

c. “I will collect my urine for a full 12 hours instead of 24 hours.” Rationale: A full 24-hour urine collection is necessary to accurately measure proteinuria and creatinine clearance. Incomplete collection may lead to inaccurate results.

Answer 78

a. Check the patient’s platelet count Rationale: Pallor, bruising, and petechiae may indicate thrombocytopenia, a complication of SLE or its treatment. A platelet count should be obtained to assess bleeding risk.

Answer 79

c. Sudden onset of hallucinations and paranoia Rationale: Corticosteroid-induced psychosis can cause hallucinations, paranoia, and severe mood changes, requiring urgent intervention.

Answer 80

b. Promote energy conservation techniques Rationale: Energy conservation techniques, such as balancing rest and activity, can help patients manage fatigue without overexertion.

Answer 81

a. Monitor for signs of infection Rationale: Patients with SLE are at increased risk for infections due to immunosuppressive therapy. Fever may indicate infection rather than a disease flare, requiring further assessment.

Answer 82

b. Recommend frequent periods of rest and assistive devices as needed Rationale: Patients with SLE often experience musculoskeletal problems, including joint pain and stiffness. Balancing rest with activity and using assistive devices can help improve mobility while preventing excessive fatigue and joint stress.

Answer 83

b. Use sunscreen and wear protective clothing when outdoors Rationale: Impaired tissue integrity in SLE, including the characteristic butterfly rash, can worsen with sun exposure. Patients should be advised to use sunscreen and wear protective clothing to prevent flare-ups and skin damage.

Answer 84

b. Teach the patient energy conservation techniques and allow flexibility in daily routines Rationale: Patients with SLE often experience fatigue and pain that can interfere with daily activities. Teaching energy conservation techniques, such as pacing activities and prioritizing tasks, helps the patient maintain independence and role function while minimizing fatigue.

Answer 85

c. Provide emotional support and discuss coping strategies for body image changes Rationale: SLE can cause visible changes, such as skin rashes and weight fluctuations from corticosteroid use, which may impact self-esteem. Providing emotional support and discussing coping strategies, such as makeup techniques and counseling, can help the patient maintain a positive self-image.

Answer 86

c. “If I start feeling stressed, I don’t need to worry about it affecting my condition.” Rationale: Emotional stress is a known trigger for SLE flares. Patients should be educated on stress management techniques to help reduce disease exacerbations.

Answer 87

a. “You will need regular eye exams every 6 to 12 months while taking this medication.” Rationale: Hydroxychloroquine can cause retinal toxicity with long-term use. Regular ophthalmologic evaluations are essential for early detection and prevention of vision loss.

Answer 88

d. “I should avoid live virus vaccines while taking immunosuppressive drugs.” Rationale: Patients with SLE who are on immunosuppressive therapy should avoid live vaccines due to the risk of infection. They should receive inactivated vaccines instead.

Answer 89

c. “Monitor the patient for signs of infection, such as fever or unusual fatigue, and report them to the provider.” Rationale: Patients with SLE are at increased risk for infection due to both the disease and immunosuppressive treatment. Early detection of infection is critical to prevent complications.

Answer 90

c. Excessive sun exposure and emotional stress Rationale: Sun exposure and emotional stress are known triggers for lupus flares. Patients should be educated to avoid prolonged sun exposure and practice stress management techniques.

Answer 91

d. “I can stop taking my corticosteroids suddenly if I don’t like the side effects.” Rationale: Corticosteroids should never be stopped abruptly, as this can lead to adrenal insufficiency and worsening of disease symptoms. They should be tapered gradually under medical supervision.

Answer 92

a. “I will plan my work activities to include periods of rest to help manage fatigue.” Rationale: Fatigue is a common symptom of SLE. Planning rest periods can help the patient maintain productivity and energy levels without worsening symptoms.

Answer 93

b. “Many patients with SLE can have successful pregnancies with proper medical management.” Rationale: While pregnancy can be high-risk for patients with SLE, many women successfully have children with careful monitoring and medical management.

Answer 94

c. Help the patient explore ways to enhance self-image, such as makeup or wigs for hair loss. Rationale: SLE can cause visible physical changes, such as skin rashes and hair loss. Encouraging adaptive strategies can help improve self-esteem and emotional well-being.

Answer 95

d. “Pace yourself and plan social activities when you feel well-rested to prevent exhaustion.” Rationale: Fatigue management strategies, such as activity pacing, allow patients with SLE to maintain a fulfilling social life while avoiding excessive exhaustion.

Answer 96

b. “Be honest about your condition and explain that you may need accommodations during flares.” Rationale: Open communication with coworkers and employers can help ensure understanding and accommodations, improving the patient’s ability to maintain a stable work-life balance.

Answer 97

a. “Pregnancy should be planned when disease activity is minimal for the best outcome.” Rationale: Pregnancy during active SLE increases the risk of complications. Planning pregnancy during a period of minimal disease activity improves outcomes.

Answer 98

b. “Hydroxychloroquine is safe during pregnancy and may help control disease activity.” Rationale: Hydroxychloroquine is considered safe in pregnancy and can help reduce SLE flares.

Answer 99

c. Intrauterine growth restriction (IUGR) Rationale: Immune complex deposition and inflammation in placental blood vessels can lead to IUGR, stillbirth, and spontaneous abortion.

Answer 100

a. “If you have severe organ involvement, pregnancy may not be recommended.” Rationale: Women with severe renal, lung, CNS, or cardiovascular involvement may be advised against pregnancy due to high maternal and fetal risks.

Answer 101

b. Assess for signs of preeclampsia and fetal distress. Rationale: SLE flares during pregnancy can mimic preeclampsia, so careful assessment of maternal and fetal well-being is essential.

Answer 102

c. “I can stop taking my medications now that my pregnancy is over.” Rationale: The postpartum period is a high-risk time for SLE flares, so patients should continue prescribed treatment.

Answer 103

b. Methotrexate Rationale: Methotrexate is teratogenic and should be stopped at least 3 months before conception.

Answer 104

d. “No, therapeutic abortion has the same risk of postdelivery exacerbation as carrying to term.” Rationale: Both pregnancy and abortion can trigger postpartum SLE flares, so patients should be monitored closely in either case.

Answer 105

b. “I apply sunscreen and wear protective clothing whenever I go outside.” Rationale: Using sunscreen and protective clothing demonstrates an understanding of disease prevention and adherence to treatment recommendations.

Answer 106

c. “I try to complete all my household chores in the morning before I get too tired.” Rationale: This approach may lead to overexertion and worsen fatigue. Patients should pace themselves and include regular rest periods.

Answer 107

d. the production of a variety of autoantibodies directed against components of the cell nucleus.

Answer 108

b. “I will use sunscreen when I am outside.” Rationale: Severe skin reactions can occur in patients with SLE who are exposed to the sun. Patients would avoid fatigue by balancing exercise with rest periods as needed. Oral contraceptives can exacerbate lupus. Aspirin and nonsteroidal antiinflammatory drugs are used to treat the musculoskeletal manifestations of SLE.

Answer 109

b. Impaired socialization Rationale: The patient‘s statement about not going anywhere because of hating the way he or she looks expresses impaired socialization, an insufficient quantity of human Interaction, 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. The rash with SLE does not impair tissue integrity. There is no evidence of impaired communication ability for this patient.

Answer 110

c. 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.

Answer 111

b. Administer varicella vaccine. Rationale: Live virus vaccines, such as varicella, are contraindicated in a patient taking immunosuppressive drugs. The other orders are appropriate for the patient.

Answer 112

b. Elevated blood urea nitrogen (BUN) Rationale: Elevated BUN and serum creatinine indicate possible lupus nephritis and a need for a change in therapy to avoid further renal damage. The positive lupus erythematosus cell prep and ANA would be expected in a patient with SLE. A drop in CRP shows decreased inflammation.

Chapter 69: SLE Flashcards

(136 cards)