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

Apply powder liberally to sensitive skin areas.

Wash the hair with a strong protein shampoo.

Use a sun-blocking agent with a sun protection factor of at least 30.

Avoid using moisturizing lotions on the skin.

Answer and Explanation

The Correct Answer is C

Choice A rationale
Applying powder to sensitive skin areas can cause dryness and irritation, exacerbating SLE symptoms. Powders can also block pores, increasing the risk of skin infections.
Choice B rationale
Using a strong protein shampoo is not relevant to managing SLE. It won't address the photosensitivity or skin issues commonly associated with SLE.
Choice C rationale
Sun protection is crucial for SLE patients due to photosensitivity. UV exposure can trigger flare-ups, making a sun-blocking agent with SPF 30 or higher essential for skin protection.
Choice D rationale
Moisturizing lotions help prevent dryness and protect the skin barrier, which is important in SLE management. Avoiding them can lead to skin complications.

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Correct Answer is A

Explanation

Choice A rationale
A raised rash across the nose and face, known as a butterfly rash, is a classic and distinctive manifestation of systemic lupus erythematosus (SLE), often exacerbated by sunlight exposure.
Choice B rationale
Hypothermia is not a common manifestation of SLE; patients more frequently experience fevers due to inflammation and immune system dysregulation.
Choice C rationale
Weight gain is not a typical direct manifestation of SLE; patients might experience weight changes due to medications or complications but not as a primary symptom.
Choice D rationale
Muscle hyperreflexia is not associated with SLE; neurological symptoms in SLE might include seizures or cognitive dysfunction, but not hyperreflexia.

Correct Answer is []

Explanation

Rationale for correct condition: Mucositis is a common side effect of chemotherapy that causes inflammation and soreness in the mouth. The client reports mouth soreness and dry mucous membranes, consistent with mucositis. The presence of mild erythema on the oral mucosa also supports this diagnosis. Chemotherapy drugs such as vincristine and anthracycline are known to cause mucositis. Addressing mucositis early is crucial for maintaining the client’s nutrition and hydration.

Rationale for actions: Providing a soft sponge toothbrush helps maintain oral hygiene without causing further irritation. Maintaining the client’s diet ensures adequate nutrition, which is essential for healing mucositis. Pad the siderails of the bed is unnecessary in this scenario, as there's no indication of seizure risk. Requesting an antiemetic is irrelevant since the client has no significant nausea or vomiting.

Rationale for parameters: Monitoring weight loss helps assess the client’s nutritional status and the effectiveness of dietary interventions. Tracking intake and output ensures the client is adequately hydrated and that oral intake is sufficient. Edema monitoring is unnecessary, as there's no sign of fluid retention. Steatorrhea is not relevant in this context, as there's no indication of fat malabsorption.

Rationale for incorrect conditions: Diarrhea is not indicated as the client’s primary complaint is mouth soreness, not gastrointestinal upset. Angioedema is characterized by swelling and is not observed in the client. Seizures are not relevant here, as the client shows no neurological signs suggestive of seizure activity.

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A nurse is providing discharge teaching to 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 preparing a presentation at a community center about systemic lupus erythematosus (SLE). The nurse should plan to include which of the following findings as a manifestation of SLE?

Correct Answer is A

Explanation

Correct Answer is []

Explanation

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