The nurse caring for a client with systemic lupus erythematosus (SLE) would include which information in teaching about triggers that can result in an exacerbation of the disease?

Use of acetaminophen to manage pain

Onset of menopause

Ultraviolet (UV) light exposure

Family history of SLE

Answer and Explanation

The Correct Answer is C

Excessive exposure to UV light, such as sunlight or tanning beds, is a known trigger for SLE exacerbations. It is important for individuals with SLE to protect their skin from the sun by wearing protective clothing, using sunscreen, and avoiding direct sunlight during peak hours. Having a family history of SLE increases the risk of developing the disease. While it is not a trigger in itself, it is an important piece of information for the client to be aware of, as it may indicate a genetic predisposition to the condition.

Acetaminophen is a commonly used over-the-counter pain reliever. While it can help manage pain associated with SLE, it is not typically considered a trigger for exacerbations. Menopause, which marks the end of a woman's reproductive years, does not directly trigger SLE exacerbations. However, hormonal changes during menopause can potentially affect disease activity in some individuals. It is important for the client to discuss any changes or concerns with their healthcare provider to manage their symptoms effectively.

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Correct Answer is ["B","C","D","G","H"]

Explanation

Low oxygen saturation: Low oxygen saturation indicates a potential respiratory compromise and should be addressed promptly to ensure adequate oxygenation and prevent further deterioration.

Previous injection drug user and alcohol misuse: Past injection drug use and alcohol misuse can have significant implications for the patient's health, including increased risk of infections, compromised immune function, and potential withdrawal symptoms. It is crucial for the nurse to be aware of these factors in order to provide appropriate care and support. Has productive cough severe enough to keep her awake: A severe productive cough that disrupts the patient's sleep suggests respiratory distress or possible worsening of the underlying condition. The nurse should assess the patient's respiratory status and implement interventions to alleviate the cough and improve rest.

Elevated temperature, pulse, and respiratory rate: An elevation in vital signs, including temperature, pulse, and respiratory rate, can indicate an infectious or inflammatory process. This warrants further assessment and intervention to manage the underlying condition. Diagnosis pneumonia: The diagnosis of pneumonia indicates a respiratory infection that requires close monitoring and appropriate treatment. The nurse should assess the patient's respiratory status, administer prescribed medications, and implement respiratory hygiene measures.

The following options are not immediate concerns or relevant assessment information:

Appointment the next day: While follow-up appointments are important, they do not require immediate attention upon receiving a hand-off report.

Marital status: Marital status is not typically an immediate concern for the nurse's assessment and care planning.

Daughter's name: The patient's family member's name is not an immediate concern or relevant assessment information for the nurse's immediate care.

Fever is present: While a fever is a symptom of an underlying condition, it is not the most critical concern.

A. Oxygen Stats B. Pulse rate and Rhythm C. Respiratory rate and depth D. Deep tendon reflexes

Correct Answer is B

Explanation

An increased serum potassium level, also known as hyperkalemia, can have adverse effects on the electrical conduction of the heart, potentially leading to life-threatening cardiac dysrhythmias. Therefore, it is crucial to assess the patient's pulse rate and rhythm promptly to identify any abnormal cardiac activity.

Assessing the oxygen saturation (oxygen stats), respiratory rate and depth, and deep tendon reflexes are also important assessments, but they are not the priority in this case. Hyperkalemia primarily affects cardiac function, and prompt identification of any potential cardiac rhythm disturbances is essential to prevent further harm.

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The nurse caring for a client with systemic lupus erythematosus (SLE) would include which information in teaching about triggers that can result in an exacerbation of the disease?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

After receiving a hand-off report what assessment information is the most important and immediate concern for the nurse? Select all that apply.

Correct Answer is ["B","C","D","G","H"]

Explanation

In reviewing the electrolytes of a patient, the nurse notes the serum potassium level has increased from 4.3 mEq/L to 5.9 mEq/L. Which assessment does the nurse initiate first to prevent further harm?

Correct Answer is B

Explanation

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Select Dropdowns: Aminoglycosides work by binding to the dropdown which prevents dropdown

A client is suffering from osteoarthritis in the knees and the nurse is providing care. The nurse is assessing the client's pain level and pain tolerance. Based on the nurse's understanding of pain, the nurse knows that a client's pain tolerance is most likely relieved by which of the following?

A client with systemic lupus erythematosus (SLE) is receiving nonsteroidal anti- inflammatory drug (NSAID) therapy. Which side effect of NSAID therapy should the nurse immediately report to the health care provider?

A child diagnosed with Kawasaki disease is brought to the clinic. The mother reports that her child is irritable, refuses to eat, and has skin peeling on both hands and feet. Which intervention should the nurse instruct the mother to implement first?