Olivia McRitchie
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NCLEX (Medical-Surgical) Nursing Test sobre Exemplar 8.4: Systemic Lupus Erythematosus, creado por Olivia McRitchie el 16/11/2018.

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Exemplar 8.4: Systemic Lupus Erythematosus

Pregunta 1 de 14

1

You have a young female nursing student just diagnosed with lupus. She's heard of this disorder, but knows very little about it and decides to ask you, the university nurse, about it. Which of the following statements made by the student nurse shows that teaching has been effective?

Selecciona una de las siguientes respuestas posibles:

  • "My body is producing antibodies against itself because of hyperreactive T-cell function."

  • "The most characteristic autoantibodies in SLE are produced in response to nucleic acids."

  • "The autoantibodies react with their corresponding antigen to form immune complexes that deposit into the body's blood vessels."

  • "The coronary blood vessels are a frequent site of complex deposition and change."

Explicación

Pregunta 2 de 14

1

A 20-year-old female patient presents to you because she's had a 100.1 degree Fahrenheit fever, appetite loss, and pain in both elbows, wrists, shoulders, ankles. and knees for the past 2 weeks. She tells you she's lost about 6 pounds and she has had a hard time concentrating on schoolwork because hasn't "felt very good", though she can't identify why. She explains that this has been happening on and off for the past two years, but she hasn't gone to the doctor about it because her symptoms haven't been this troublesome before.

What follow up question would you want to ask this patient?

Selecciona una de las siguientes respuestas posibles:

  • "Have you had any fungal infections lately?"

  • "Are you on any antipsychotic medications?"

  • "Have you ever gotten a red rash on your cheeks and the bridge of your nose?"

  • "Have you had regular menses?"

Explicación

Pregunta 3 de 14

1

You are a nurse in a doctor's office about to see a male patient that has been taking procainamide for a little over a year. What questions might you ask this patient when he comes in?

Selecciona una o más de las siguientes respuestas posibles:

  • "Have you been experiencing any new pain in your joints?"

  • "Have you been experiencing any new or increasing memory loss, disorientation, personality changes, depression, or psychoses?"

  • "Have you been noticing foamy urine, swelling in your abdomen and extremities, and weight gain?"

  • "Have you had diarrhea, abdominal pain, nausea, and decreased desire to eat?"

  • "Have you had any raised, scaly, circular lesions that has redness around them?"

  • "Have you been fatigued and experiencing bleeding gums, nosebleeds, or increased bruising?"

Explicación

Pregunta 4 de 14

1

Select the medications that have potential to cause drug-induced lupus.

Selecciona una o más de las siguientes respuestas posibles:

  • Procainamide

  • Hydralazine

  • Isoniazid

  • Sertraline

  • Hydroxychloroquinolone

  • Prednisolone

Explicación

Pregunta 5 de 14

1

Your female lupus patient is presenting with severe weakness, fatigue, dyspnea, and heart palpitations. She reports that her grades have been dropping because she's too exhausted to do anything and she can't concentrate. She is pale, her skin is cold, and the tips of her fingers are slightly cyanotic.

Her heart rhythm is sinus rhythm; upon auscultation, S1 and S2 could clearly be heard, no extra sounds or murmurs identified. Her hematocrit is 22% and her hemoglobin is 7.5 g/dL.

Which of the following orders should you place FIRST?

Selecciona una de las siguientes respuestas posibles:

  • ECG

  • Retake the CBC

  • 50 units/kg epoetin alpha, subcutaneous

  • 1 unit of blood of the appropriate blood type

Explicación

Pregunta 6 de 14

1

A patient with lupus is in the doctor's office during a flare up. She complaining about getting random nose bleeds, gum bleeds, and bruising. She is embarrassed to wear skirts and short sleeved shirts because of the extensive bruising and "bumpy, non-itchy rashes" (petechiae) on her skin. It is even interfering with her relationship with her fiance; due to the extensive bruising and the patient trying to cover it up, people will assume that her fiance is abusing her and act judgmentally.

Which of the following orders will you suggest to the doctor for this patient?

Selecciona una de las siguientes respuestas posibles:

  • 5 mg prednisone, PO, BID.

  • Hospital referral for IV platelet transfusion

  • Hospital referral for IV IgG

  • 1 mg/kg azathioprine IV BID for 6-8 wks

Explicación

Pregunta 7 de 14

1

A lupus patient presents with chest pain radiating to his back., dry cough, fever, and anxiety. He reports that he is very tired, but he can't lay down and rest because that makes the pain worse. He is pale and cold. Upon auscultation you hear a high-pitched grating sound, no crackles or rales in the lungs. Telemetry and ECG shows ST elevation and PR depression.

Which of the following interventions should you order FIRST?

Selecciona una de las siguientes respuestas posibles:

  • Pericardiocentesis

  • 40 mg prednisone, PO, BID.

  • 1,000 mg nafcillin PO, QID

  • 1.2 mg colchicine PO, then 0.6 mg 1 hr later

Explicación

Pregunta 8 de 14

1

You are concerned that the patient you are caring for might have systemic lupus erythematosus. Which tests might you order?

Selecciona una o más de las siguientes respuestas posibles:

  • Anti-DNA antibody testing.

  • Erythrocyte sedimentation rate.

  • Serum complement levels.

  • Complete blood count

  • Enzyme-linked immunoabsorbent array.

  • Western blot antibody testing

Explicación

Pregunta 9 de 14

1

You have a patient presenting to the hospital with anasarca, with increased edema in the hands, feet, and face; fatigue; anorexia; and foamy urine. This patient has been diagnosed with lupus in the past. What tests might you order?

Selecciona una o más de las siguientes respuestas posibles:

  • Urinalysis

  • Renal function tests

  • Anti-DNA antibody testing

  • Erythrocyte sedimentation rate

Explicación

Pregunta 10 de 14

1

Which of the following instructions is important to give to a female patient taking hydroxychloroquine?

Selecciona una de las siguientes respuestas posibles:

  • "You should see an ophthalmologist every 6 months."

  • "Avoid large crowds and situations that increase exposure to infection."

  • "Refrain from taking aspirin or ibuprofen."

  • "Your menses may cease while taking the drug."

Explicación

Pregunta 11 de 14

1

What are your responsibilities when taking care of a patient on IV azathioprine?

Selecciona una o más de las siguientes respuestas posibles:

  • Monitor white blood cell and platelet counts.

  • Monitor creatinine, BUN, creatinine clearance, and liver enzyme levels.

  • Administer with food.

  • Increase fluids & monitor I&O

  • Monitor for petechiae & ask the patient to report bleeding gums, joint pain, hematuria, and black or tarry stools.

  • Monitor pulmonary function studies.

Explicación

Pregunta 12 de 14

1

You have just taught a patient about precautions to take to prevent infection while taking cyclophosphamide. Which of the following statements made by the patient shows that teaching has been effective?

Selecciona una de las siguientes respuestas posibles:

  • "I need to call my doctor if I start having difficulty breathing."

  • "I can still go to a house party Saturday."

  • "Ibuprofen may be helpful for pain relief."

  • "If I stop menstruating, I should be concerned."

Explicación

Pregunta 13 de 14

1

You have a female patient admitted to the hospital with pericarditis due to an acute flare up of lupus. She also has kidney damage due to extensive renal involvement. She has been prescribed prednisone and cyclophosphamide to control her disease.

Select appropriate interventions for this patient.

Selecciona una o más de las siguientes respuestas posibles:

  • Take vital signs every 4 hours.

  • Closely monitor CBC w/WBC differential, organ function studies, and electrolyte status.

  • Initiate protective isolation procedures.

  • Monitor I&O and take daily weights.

  • Assess the extremities for edema during each patient interaction.

  • Administer ibuprofen to treat arthritis.

  • Increase fluid intake.

Explicación

Pregunta 14 de 14

1

You have a 20-year-old patient recently diagnosed with lupus. She is wondering how to avoid acute exasperation and painful dermatological manifestations of the disease. Which of the following interventions is not correct advice to give to the patient?

Selecciona una de las siguientes respuestas posibles:

  • Avoid outdoor activities between 10:00 AM and 3:00 PM, if at all possible.

  • Sunscreen is not helpful in limiting sun exposure.

  • Keep your skin clean and dry by utilizing mild soaps on the skin.

  • Limit your usage of cosmetics

  • Avoid smoking, alcohol, and drugs.

  • Avoid utilizing estrogen-containing birth control pills.

  • Avoid fluorescent lighting, if possible.

  • Talk to your dentist about effective ways to maintain good oral hygiene.

Explicación

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