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

Answer and Explanation

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.

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Correct Answer is B

Explanation

A. Provide chilled formula: Chilled formula can be less palatable and may cause gastrointestinal discomfort, potentially worsening diarrhea. Room temperature or slightly warmed formula is generally recommended for enteral feedings to enhance tolerance and digestion.

B. Administer feedings at a slower rate: Slowing the rate of enteral feedings can help reduce gastrointestinal irritation and improve absorption, which may be particularly beneficial for a client experiencing diarrhea. This approach allows the intestines more time to process the nutrients, potentially alleviating symptoms.

C. Discard the open can of formula after 36 hr: While proper storage is important, many enteral formulas can be stored for up to 48 hours once opened. The key is to ensure the formula is stored correctly to prevent bacterial growth, but the 36-hour guideline may not be strictly necessary in all cases.

D. Flush the tube with 10 mL of water after feedings: Flushing the tube is a good practice to maintain tube patency, but the volume may not be adequate depending on the tube size and the specific protocol. Adequate flushing is essential, but it does not directly address the issue of diarrhea, which is the priority concern in this scenario.

A. "You should give your child a clear liquid diet for 24 hr." B. "Your child can take a tub bath this evening." C. "Your child should stay out of school for 7 days following the procedure." D. "You should remove your child's pressure dressing tomorrow."

Correct Answer is D

Explanation

A) “You should give your child a clear liquid diet for 24 hr.”:A clear liquid diet is not typically required following a cardiac catheterization. The child can usually resume a regular diet unless otherwise instructed by the healthcare provider.

B) “Your child can take a tub bath this evening.”:Tub baths should be avoided immediately after a cardiac catheterization to prevent infection at the catheter insertion site. Sponge baths are usually recommended until the site has healed.

C) “Your child should stay out of school for 7 days following the procedure.”:While some rest is necessary, staying out of school for 7 days is generally not required. The child can usually return to school within a few days, depending on their recovery and the healthcare provider’s advice.

D) “You should remove your child’s pressure dressing tomorrow.”:Removing the pressure dressing the day after the procedure is a common instruction. It allows the site to be inspected for any signs of infection or complications and ensures proper healing.

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A nurse is caring for a client who has systemic lupus erythematosus. Which of the following client findings should the nurse expect?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has diarrhea and is receiving intermittent enteral feedings. Which of the following actions should the nurse take?

Correct Answer is B

Explanation

A nurse is providing discharge teaching for the guardian of a school-age child following a cardiac catheterization. Which of the following instructions should the nurse include in the teaching?

Correct Answer is D

Explanation

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