The nurse is assessing a patient who has been admitted with an exacerbation of systemic lupus erythematosus (SLE). Which patient findings are the nurse's priority to address?

Joint swelling, tenderness, and pain with movement.

Red ulcers on the buccal mucosa.

Malar and discoid rashes.

Dark, foamy urine.

Answer and Explanation

The Correct Answer is D

Choice A reason: Joint swelling, tenderness, and pain with movement are common symptoms of systemic lupus erythematosus (SLE) but are not immediately life-threatening. They should be managed but are not the priority in this case.

Choice B reason: Red ulcers on the buccal mucosa are a concerning finding in SLE and can indicate active disease, but they are not the priority compared to signs of potential kidney involvement.

Choice C reason: Malar and discoid rashes are typical

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Correct Answer is B

Explanation

Choice A reason: Lethargy and hypoxia are not typically associated with respiratory alkalosis. Respiratory alkalosis occurs when there is excessive exhalation of carbon dioxide, leading to a decrease in blood CO2 levels and an increase in pH. Lethargy and hypoxia are more often related to respiratory acidosis, where CO2 accumulates due to hypoventilation.

Choice B reason: Light-headedness and muscle spasms are common clinical manifestations of respiratory alkalosis. The decrease in carbon dioxide (CO2) levels leads to cerebral vasoconstriction, resulting in light-headedness or dizziness. Additionally, respiratory alkalosis can cause a shift of calcium in the blood, leading to muscle spasms, tingling, and even tetany.

Choice C reason: Hypotension and respiratory depression are not typical findings in respiratory alkalosis. Hypotension can be a symptom of various conditions but is not directly associated with respiratory alkalosis. Respiratory depression is related to hypoventilation and respiratory acidosis, not hyperventilation.

Choice D reason: Muscle twitching and hyperkalaemia are not manifestations of respiratory alkalosis. Hyperkalaemia is more commonly seen in metabolic acidosis and not in respiratory alkalosis. Muscle twitching can occur in various conditions, but respiratory alkalosis typically causes muscle spasms and tetany due to calcium shifts.

A. Recheck blood glucose immediately. B. Provide 15 grams of fast-acting carbohydrates. C. Administer 1 mg of glucagon intramuscularly. D. Prepare an insulin subcutaneous injection.

Correct Answer is B

Explanation

Choice A reason: Rechecking blood glucose immediately is not the appropriate immediate intervention when a patient shows signs of hypoglycaemia with a blood glucose level of 55 mg/dL. Immediate treatment is needed to raise the blood glucose level to prevent further complications.

Choice B reason: Providing 15 grams of fast-acting carbohydrates is the immediate intervention for a patient with hypoglycaemia. Fast-acting carbohydrates such as glucose tablets, juice, or regular soda can quickly raise blood glucose levels. This intervention addresses the immediate need to correct hypoglycaemia symptoms such as diaphoresis and palpitations.

Choice C reason: Administering 1 mg of glucagon intramuscularly is typically reserved for severe hypoglycaemia when the patient is unconscious or unable to ingest carbohydrates. In this scenario, the patient is conscious and able to consume fast-acting carbohydrates.

Choice D reason: Preparing an insulin subcutaneous injection is not appropriate for treating hypoglycaemia. Insulin lowers blood glucose levels and would worsen the patient's hypoglycaemic state.

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The nurse is assessing a patient who has been admitted with an exacerbation of systemic lupus erythematosus (SLE). Which patient findings are the nurse's priority to address?

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Naxlex Comprehensive Predictor Exams

The nurse is caring for a patient with respiratory alkalosis. Which clinical manifestations will the nurse expect to find?

Correct Answer is B

Explanation

The nurse is caring for a patient with type 2 diabetes who reports diaphoresis and palpitations. A blood glucose check reveals a level of 55 mg/dL. What is the nurse's immediate intervention?

Correct Answer is B

Explanation

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The nurse is caring for a patient with hyperosmolar hyperglycemic syndrome. The patient is receiving intravenous fluids of normal saline with 20 mEq of potassium chloride and a continuous insulin infusion. Which finding will indicate to the nurse that the treatment is effective?