A nurse is performing discharge teaching for a client who has systemic lupus erythematosus (SLE). Which of the following instructions should the nurse include?

Wash your hair with a mild protein shampoo.

Apply powder liberally to sensitive skin areas.

Use a sun blocking agent with a sun protection factor of at least 15.

Avoid using moisturizing lotions on your skin.

Answer and Explanation

The Correct Answer is C

Choice A reason: This is incorrect. While gentle hair care is important, it is not as critical as sun protection for SLE patients.

Choice B reason: This is incorrect. Powder can be drying, and SLE patients often need to keep their skin moisturized.

Choice C reason: This is correct. SLE patients are often photosensitive and need to protect their skin from UV rays.

Choice D reason: This is incorrect. SLE patients should keep their skin well moisturized to prevent dryness.

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Correct Answer is C

Explanation

Choice A reason: Weighing the client daily is important for monitoring fluid balance but is not the most immediate action to prevent an Addisonian crisis.

Choice B reason: Restricting fluid intake is not appropriate for a client at risk for Addisonian crisis, as they may require increased fluids to prevent dehydration.

Choice C reason: This is the correct action. Clients with Addison's disease require corticosteroids to replace the hormones that their adrenal glands are not producing.

Choice D reason: Providing a low carbohydrate diet is not relevant to the prevention of an Addisonian crisis.

A. Chest tube eyelets not visible B. Development of subcutaneous emphysema C. Presence of tidal fluctuation in the water seal chamber D. Continuous bubbling in the suction control chamber

Correct Answer is B

Explanation

Choice A reason: The visibility of chest tube eyelets is not typically a concern unless there is evidence that the tube is dislodged. In normal circumstances, the eyelets may not be visible, and this does not necessarily indicate a need for intervention.

Choice B reason: The development of subcutaneous emphysema, which is the presence of air in the subcutaneous tissue, can be a sign of a serious complication such as a pneumothorax. It requires immediate assessment and possible intervention to prevent further complications.

Choice C reason: Tidal fluctuation in the water seal chamber is a normal finding when a chest tube is in place. It indicates that the system is patent and functioning correctly as it reflects the pressure changes in the pleural space during respiration.

Choice D reason: Continuous bubbling in the suction control chamber may indicate an air leak in the system, which could be normal if the system is set to continuous suction. However, if the bubbling is vigorous and the system is not set to continuous suction, it may indicate a new air leak and require intervention.

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A nurse is performing discharge teaching for a client who has systemic lupus erythematosus (SLE). Which of the following instructions should the nurse include?

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has Addison's disease and is at risk for Addisonian crisis. Which of the following actions should the nurse take?

Correct Answer is C

Explanation

A nurse is assessing a client who is 1 day postoperative following a lobectomy and has a chest tube drainage system in place. Which of the following findings by the nurse indicates a need for intervention?

Correct Answer is B

Explanation

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