What are the causes of a pressure ulcer? (Select all that apply.)

Choice A reason: This is an incorrect answer because Medicare is a federal health insurance program that covers certain groups of people, such as the elderly, the disabled, and the lowincome. Medicare does not publish the National Patient Safety Goals, but it does have its own quality and safety standards that health care providers must meet to receive reimbursement.

Choice B reason: This is an incorrect answer because the American Nurses Association (ANA) is a professional organization that represents the interests of registered nurses in the United States. The ANA does not publish the National Patient Safety Goals, but it does have its own code of ethics, standards of practice, and policies that guide nursing practice and promote quality and safety.

Choice C reason: This is the correct answer because the Joint Commission is an independent, nonprofit organization that accredits and certifies more than 22,000 health care organizations and programs in the United States. The Joint Commission publishes the National Patient Safety Goals, which are specific and measurable goals that address the most critical patient safety issues in health care. The Joint Commission updates the goals annually based on the latest evidence and expert input.

Choice D reason: This is an incorrect answer because the Institute of Medicine (IOM) is a division of the National Academies of Sciences, Engineering, and Medicine, which is a private, nonprofit organization that provides independent, objective, and authoritative advice to inform policy and practice. The IOM does not publish the National Patient Safety Goals, but it does conduct research and issue reports on various topics related to health and health care, including quality and safety.

Choice A reason: The client having a butterfly rash is not a concerning finding in a client with SLE. A butterfly rash is a malar rash that appears across the cheeks and the bridge of the nose. It is a common sign of SLE and may flare up or fade depending on the disease activity. It does not indicate any serious complication or organ damage.

Choice B reason: A blood pressure of 126/85 mm Hg is not a concerning finding in a client with SLE. This blood pressure is within the normal range and does not indicate hypertension or hypotension. Hypertension is a possible complication of SLE that may affect the kidneys, the heart, or the brain. Hypotension may indicate shock, dehydration, or infection.

Choice C reason: The client reporting chronic fatigue is not a concerning finding in a client with SLE. Chronic fatigue is a common symptom of SLE that affects the quality of life and the ability to perform daily activities. It may be caused by inflammation, pain, anemia, depression, or medication side effects. It does not indicate any acute or lifethreatening condition.

Choice D reason: A urine output of 20 mL/hour is a concerning finding in a client with SLE. This urine output is below the normal range of 30 to 50 mL/hour and indicates oliguria, which is a reduced urine production. Oliguria may indicate acute kidney injury, which is a serious complication of SLE that may lead to renal failure or death. The nurse should monitor the client's urine output, fluid balance, electrolytes, and kidney function and report any abnormal findings to the provider.