A nurse in a provider's office is reinforcing teaching about skin care with a client who has a new diagnosis of systemic lupus erythematosus. Which of the following statements by the client indicates an understanding of the teaching?
"I will limit my time in the tanning bed to 15 minutes."
"I will dry my skin by patting it with a towel."
"I will use an astringent on my face."
"I will cleanse my skin using an antibacterial soap."
The Correct Answer is B
People with SLE are often sensitive to sunlight and should take precautions to protect their skin. Limiting time in the tanning bed is important because exposure to ultraviolet (UV) light can trigger or worsen symptoms of SLE. Using an astringent on the face and cleansing with an antibacterial soap may not be recommended for individuals with SLE, as these products can be harsh on the skin and may cause irritation. However, patting the skin dry with a towel is a gentle and appropriate method to dry the skin without causing unnecessary friction or irritation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
This statement shows that the client understands the threshold for high blood pressure readings. A blood pressure reading of 140/90 mmHg or higher is considered elevated or hypertensive.
It is important for the client to be aware of this value and to seek medical attention or follow the prescribed management plan if their blood pressure exceeds this threshold.
The hand should be supported at the level of the heart or positioned comfortably during blood pressure measurement, but it does not need to be specifically 6 inches below the heart.
Consistency in the timing of blood pressure measurements is important for accurate monitoring. It is generally recommended to measure blood pressure at the same time each day to account for variations that can occur throughout the day.
The blood pressure cuff should be snug but not too tight around the upper arm. It should fit comfortably and securely to ensure accurate readings.
Correct Answer is D
Explanation
The first action the nurse should take in this situation is to assess the client's condition for any injuries or signs of distress. Therefore, the nurse should measure the client's vital signs to determine if there are any immediate concerns such as hypotension or tachycardia. After ensuring the client's safety and addressing any immediate needs, the nurse should complete an incident report and document the fall in the client's medical record. The provider may also need to be notified depending on the severity of the fall and any resulting injuries.
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