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.
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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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: A rosebud like stoma orifice is a normal appearance for a new colostomy, indicating that the stoma is healthy and not in distress.
Choice B reason: Red drainage from a stoma can be normal, especially in the early postoperative period, as the stoma may ooze a small amount of blood. However, if the drainage is excessive or persistent, it should be reported.
Choice C reason: A shiny, moist stoma is also a sign of a healthy stoma. The stoma should be moist and have a pink or red color, similar to the inside of the mouth.
Choice D reason: A purplish colored stoma indicates compromised blood flow and is a sign of ischemia. This is a serious complication that requires immediate medical attention to prevent tissue death.
Correct Answer is D
Explanation
Choice A reason: Infusing packed RBCs over 1 hour is typically too rapid for most patients and can increase the risk of adverse reactions, especially in those with cardiovascular compromise.
Choice B reason: A 2hour infusion may be appropriate in certain emergency situations where rapid correction of anemia is required, but it is not the standard practice for routine transfusions.
Choice C reason: A 3hour infusion is less commonly used and does not provide any specific advantage over the standard 4hour infusion time.
Choice D reason: The standard practice is to complete the transfusion of packed RBCs within 4 hours. This duration minimizes the risk of bacterial growth and transfusion reactions, as recommended by the American Society of Hematology and other clinical guidelines.
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