A nurse is caring for a client who has systemic lupus erythematosus. Which of the following client findings should the nurse expect?
Kaposi's sarcoma lesions
Hemangiomas
Psoriasis
Raised facial rash
The Correct Answer is D
A) Kaposi's sarcoma lesions: Kaposi's sarcoma is a cancer that commonly appears in individuals with immunocompromised states, such as those with HIV/AIDS. It is not associated with systemic lupus erythematosus (SLE). Therefore, finding Kaposi's sarcoma lesions would not be expected in a client with SLE.
B) Hemangiomas: Hemangiomas are benign vascular tumors typically seen in infants and children. While they can occur in various skin conditions, they are not characteristic of systemic lupus erythematosus. Thus, finding hemangiomas would not be relevant in this context.
C) Psoriasis: Psoriasis is a chronic autoimmune condition that causes red, scaly patches on the skin. While both psoriasis and lupus are autoimmune disorders, the specific skin manifestations of lupus differ from those of psoriasis. Therefore, a nurse would not expect to find psoriasis in a client with systemic lupus erythematosus.
D) Raised facial rash: A raised facial rash, often described as a "butterfly rash," is a classic manifestation of systemic lupus erythematosus. This rash typically appears across the cheeks and nose and is associated with photosensitivity, making it a key finding when assessing clients with SLE. Thus, the presence of a raised facial rash is an expected and significant finding in this condition.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A) "Limit the time your infant feeds to 10 minutes on each breast.": Limiting feeding time can be detrimental, as infants often need varying lengths of time to effectively nurse. It's essential to allow the infant to feed as long as they need to ensure adequate milk intake and to stimulate milk production.
B) "Supplement breastfeeding with water every 12 hours.": Breastfed infants typically do not need supplemental water in the first six months of life, as breast milk provides all necessary hydration and nutrients. Offering water can fill the infant's stomach and reduce breastfeeding frequency, impacting nutrition.
C) "Begin each feeding using the same breast.": It's common to start with one breast and then offer the second breast if the infant is still hungry. However, alternating which breast to start with at each feeding can help maintain an even milk supply and prevent engorgement.
D) "Offer your infant the breast when he shows signs of hunger.": This is the most appropriate recommendation. Recognizing and responding to hunger cues—such as rooting, smacking lips, or increased alertness—promotes successful breastfeeding and ensures that the infant is receiving adequate nutrition.
Correct Answer is A
Explanation
A. Place the client in Trendelenburg position: This position helps relieve pressure on the umbilical cord, potentially improving blood flow to the fetus. It is an appropriate immediate intervention for a prolapsed cord.
B. Apply fundal pressure: This is contraindicated in cases of cord prolapse as it can exacerbate the situation by pushing the presenting part further down and increasing pressure on the cord.
C. Loosely wrap the cord with petroleum gauze: While protecting the cord is important, simply wrapping it does not address the immediate need to relieve pressure and restore blood flow to the fetus.
D. Evaluate uterine tone: While assessing uterine tone is important during labor, the immediate priority when a prolapsed cord is noted is to relieve pressure on the cord to prevent fetal compromise. Therefore, this step should not be the first action taken.
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