EXAM 4 256 EXAM QUESTIONS WITH COMPLETE
SOLUTIONS GUARANTEED PASS (2025/2026)
SLE teaching - ANSWER ->· Protect the skin o Limit sun/ultraviolet light
exposure to prevent exacerbation (fluorescent light too) § Long sleeves, lg-
brimmed hat, SPF 30+ o Clean skin with mild soap, pat dry and apply
lotion o COSMETICS OK W/
MOSIURIZERS, AND SUN PROTECTION, NO EXCESS
POWDER OR DRYING
SUBSTANCES
· MONITOR TEMP- first sign of exacerbation · Avoid large crowds and
people who are ill, bc immunosuppressed
· AVOID HARSH HAIR TX (permanents or highlights)
Pregnancy can cause exacerbation
Systemic Sclerosis (Scleroderma) - ANSWER -
>***SWALOWING PROBLEM***
· Uncommon, chronic, inflammatory, autoimmune connective tissue
disease.
· Similar to SLE, but w/a higher mortality rate
· DOESNT RESPOND TO STEROIDS OR
IMMUNOSUPPRESANTS, WHY MORTALITY IS HIGHER
THAN SLE
· Inflamed tissue becomes fibrotic and then sclerotic
(hard) - renal involvement leading cause of death
· Women 25-55, most in 40s
Diffuse cutaneous scleroderma - ANSWER ->· *Major organ problems
o FIRST SX- HAND AND FOREARM EDEMA W/ OR W/O
BILATERAL CARPAL TUNNEL SYNDROME o Skin thickening on
trunk, face, and proximal and distal extremities (most of the body)
,o Painless symmetric pitting edema of hands & fingers (sausage like
fingers) o Changes of pigmentation with loss of skin folds & face can
become mask like
o Develop early problems w/ GI tract (GERD to
dysphagia), heart(myocardial fibrosis), lungs (fibrosis &
PAH), & kidneys (malignant HTN) o
Complications can be rapid Limites cutaneous scleroderma - ANSWER
>· *Esophagus o Skin thickening limited to sites distal to face, neck and
distal extremities o Organ changes rare or late o CREST Syndrome
§ Calcinosis - calcium deposits in tissues
§ RAYNAUDS PHENOMENON-intermittent vasospasm of finger tips - first
CREST symptom that develops § ESOPHAGEAL DYSMOTILITY-
**Dysphagia**
§ Sclerodactyly - scleroderma of digits - fingers stiff, shiny, and no skin
folds
§ Telangiectasia - capillary dilations that form vascular lesions on face, lips
& fingers
Scleroderma medications - ANSWER ->o Medications - Tx sx
§ Vasoactive agents - CCB for Raynaud's symptoms
§ Anti - inflammatory meds - steroids
§ Immunosuppressants o Reduce renal complications §
ACE inhibitors and HTN control o Treat PAH (Pulmonary
Artery Hypertension)
§ Bosentan - endothelin receptor antagonist - Liver toxic allergy -
ANSWER ->***EPI PEN, STOP INFUSION, LATEX
CONDOM USE***
· "Hypersensitivity" increased immune response to the presence of an
allergen "antigen"
scleroderma nursing management - ANSWER ->o Keep HOB elevated 60
degrees during meals and at least an hour after o Maintain skin integrity-
esp with steroids & vasospasm o Small frequent meals w/semisoft foods -
avoid liquids (thickit) due r/f choking - small amounts & chew well o Teach
,to avoid foods that inc gastric secretion-spices, caffeine, pepper o
Promote bowel elimination - have both constipation &
diarrhea
scleroderma pt education - ANSWER ->o How to dress in cold weather-
gloves, socks, etc.
o Eliminate alcohol, cigarettes, extreme stress, and
caffeine (vasoconstrictive) o Biofeedback for stress management
o Disease process - Only gets worse
allergy diagnostics - ANSWER ->o Allergy skin testing -
Has to be red & raised
§ avoid antihistamines & corticosteroid inhalers 2 weeks before testing
§ Emergency equipment (resuscitation bag, suction, IV, drugs) for
anaphylaxis o RAST (radioallerosorbent test) or fluroenzyme blood tests
used to measure IgE levels to specific allergens o Pulmonary function
measurements for allergic asthma o Blood test measuring levels of IgE
(normal 39 IU/ml) o CBC may show inc eosinophils
(normal 1-2%)
allergy rhinitis - ANSWER ->§ Histamine causes capillary leak, nasal &
conjunctival mucus secretion, & itching w/redness
§ Allergic rhinitis has rhinorrhea (runny nose), stuffy nose, & itchy, watery
eyes
§ Clear or white nasal drainage, HA or feel pressure
Food allergy vs food intolerance - ANSWER ->§ 8 foods 90% of true food
allergies - milk, eggs, peanut, tree nuts, shellfish, fish, soybeans & wheat
Diagnosis & treatment are avoidance
atopic dermatitis - ANSWER ->§ No cure but goal is to control symptoms
with antihistamines & topical steroids § Lesions red, itchy, contain exudates
- may be drier in elderly
Lesions typically found on cheeks, scalp, & forehead
, Urticaria - ANSWER ->o "hives"
§ Papules or plaques that often fade within 24 hrs.
§ If hives last over 6 weeks - chronic urticaria
§ ASA & NSAIDS can exacerbate hives- §
Antihistamines mainstay of treatment anaphylaxis -
ANSWER ->o (Distributed Vasodilated
Shock)
§ Most common causes drugs, food, latex exposure, insect bites & stings
(BEES)
§ Symptoms
· Often present with hives, angioedema, dyspnea & wheezing
· Syncope, hypotension
· N&V, diarrhea, abd pain
· Flushing, headache, rhinitis, itching
· CV collapse, shock, resp tract obstruction § Symptoms can begin 5-30
min after encountering trigger or be delayed an hour or more
Anaphylaxis treatment - ANSWER ->· Assess respiratory status, airway &
O2 sat (do not run and get a probe)
· Call the Rapid Response Team
· Oxygen via non-rebreather 90-100% and have intubation/tracheostomy
equipment ready
· 1st - Immediately discontinue IV drug and changing the tubing and hang
NS
· Prepare to administer Epinephrine IV OR EPI PEN · Elevate HOB 45
degrees if BP normal, 10 degrees if hypotensive
· Reassure patient frequently
allergy medications - ANSWER ->§ Antihistamines - diphenhydramine - 2nd
line drugs (angioedema & urticaria)
§ Decongestants - most OTC - are sympathomimetic
§ Steroids - 2nd line drugs
· Nasal sprays - beclomethasone, triamcinolone, fluticasone (limit 5 days
at a time)
SOLUTIONS GUARANTEED PASS (2025/2026)
SLE teaching - ANSWER ->· Protect the skin o Limit sun/ultraviolet light
exposure to prevent exacerbation (fluorescent light too) § Long sleeves, lg-
brimmed hat, SPF 30+ o Clean skin with mild soap, pat dry and apply
lotion o COSMETICS OK W/
MOSIURIZERS, AND SUN PROTECTION, NO EXCESS
POWDER OR DRYING
SUBSTANCES
· MONITOR TEMP- first sign of exacerbation · Avoid large crowds and
people who are ill, bc immunosuppressed
· AVOID HARSH HAIR TX (permanents or highlights)
Pregnancy can cause exacerbation
Systemic Sclerosis (Scleroderma) - ANSWER -
>***SWALOWING PROBLEM***
· Uncommon, chronic, inflammatory, autoimmune connective tissue
disease.
· Similar to SLE, but w/a higher mortality rate
· DOESNT RESPOND TO STEROIDS OR
IMMUNOSUPPRESANTS, WHY MORTALITY IS HIGHER
THAN SLE
· Inflamed tissue becomes fibrotic and then sclerotic
(hard) - renal involvement leading cause of death
· Women 25-55, most in 40s
Diffuse cutaneous scleroderma - ANSWER ->· *Major organ problems
o FIRST SX- HAND AND FOREARM EDEMA W/ OR W/O
BILATERAL CARPAL TUNNEL SYNDROME o Skin thickening on
trunk, face, and proximal and distal extremities (most of the body)
,o Painless symmetric pitting edema of hands & fingers (sausage like
fingers) o Changes of pigmentation with loss of skin folds & face can
become mask like
o Develop early problems w/ GI tract (GERD to
dysphagia), heart(myocardial fibrosis), lungs (fibrosis &
PAH), & kidneys (malignant HTN) o
Complications can be rapid Limites cutaneous scleroderma - ANSWER
>· *Esophagus o Skin thickening limited to sites distal to face, neck and
distal extremities o Organ changes rare or late o CREST Syndrome
§ Calcinosis - calcium deposits in tissues
§ RAYNAUDS PHENOMENON-intermittent vasospasm of finger tips - first
CREST symptom that develops § ESOPHAGEAL DYSMOTILITY-
**Dysphagia**
§ Sclerodactyly - scleroderma of digits - fingers stiff, shiny, and no skin
folds
§ Telangiectasia - capillary dilations that form vascular lesions on face, lips
& fingers
Scleroderma medications - ANSWER ->o Medications - Tx sx
§ Vasoactive agents - CCB for Raynaud's symptoms
§ Anti - inflammatory meds - steroids
§ Immunosuppressants o Reduce renal complications §
ACE inhibitors and HTN control o Treat PAH (Pulmonary
Artery Hypertension)
§ Bosentan - endothelin receptor antagonist - Liver toxic allergy -
ANSWER ->***EPI PEN, STOP INFUSION, LATEX
CONDOM USE***
· "Hypersensitivity" increased immune response to the presence of an
allergen "antigen"
scleroderma nursing management - ANSWER ->o Keep HOB elevated 60
degrees during meals and at least an hour after o Maintain skin integrity-
esp with steroids & vasospasm o Small frequent meals w/semisoft foods -
avoid liquids (thickit) due r/f choking - small amounts & chew well o Teach
,to avoid foods that inc gastric secretion-spices, caffeine, pepper o
Promote bowel elimination - have both constipation &
diarrhea
scleroderma pt education - ANSWER ->o How to dress in cold weather-
gloves, socks, etc.
o Eliminate alcohol, cigarettes, extreme stress, and
caffeine (vasoconstrictive) o Biofeedback for stress management
o Disease process - Only gets worse
allergy diagnostics - ANSWER ->o Allergy skin testing -
Has to be red & raised
§ avoid antihistamines & corticosteroid inhalers 2 weeks before testing
§ Emergency equipment (resuscitation bag, suction, IV, drugs) for
anaphylaxis o RAST (radioallerosorbent test) or fluroenzyme blood tests
used to measure IgE levels to specific allergens o Pulmonary function
measurements for allergic asthma o Blood test measuring levels of IgE
(normal 39 IU/ml) o CBC may show inc eosinophils
(normal 1-2%)
allergy rhinitis - ANSWER ->§ Histamine causes capillary leak, nasal &
conjunctival mucus secretion, & itching w/redness
§ Allergic rhinitis has rhinorrhea (runny nose), stuffy nose, & itchy, watery
eyes
§ Clear or white nasal drainage, HA or feel pressure
Food allergy vs food intolerance - ANSWER ->§ 8 foods 90% of true food
allergies - milk, eggs, peanut, tree nuts, shellfish, fish, soybeans & wheat
Diagnosis & treatment are avoidance
atopic dermatitis - ANSWER ->§ No cure but goal is to control symptoms
with antihistamines & topical steroids § Lesions red, itchy, contain exudates
- may be drier in elderly
Lesions typically found on cheeks, scalp, & forehead
, Urticaria - ANSWER ->o "hives"
§ Papules or plaques that often fade within 24 hrs.
§ If hives last over 6 weeks - chronic urticaria
§ ASA & NSAIDS can exacerbate hives- §
Antihistamines mainstay of treatment anaphylaxis -
ANSWER ->o (Distributed Vasodilated
Shock)
§ Most common causes drugs, food, latex exposure, insect bites & stings
(BEES)
§ Symptoms
· Often present with hives, angioedema, dyspnea & wheezing
· Syncope, hypotension
· N&V, diarrhea, abd pain
· Flushing, headache, rhinitis, itching
· CV collapse, shock, resp tract obstruction § Symptoms can begin 5-30
min after encountering trigger or be delayed an hour or more
Anaphylaxis treatment - ANSWER ->· Assess respiratory status, airway &
O2 sat (do not run and get a probe)
· Call the Rapid Response Team
· Oxygen via non-rebreather 90-100% and have intubation/tracheostomy
equipment ready
· 1st - Immediately discontinue IV drug and changing the tubing and hang
NS
· Prepare to administer Epinephrine IV OR EPI PEN · Elevate HOB 45
degrees if BP normal, 10 degrees if hypotensive
· Reassure patient frequently
allergy medications - ANSWER ->§ Antihistamines - diphenhydramine - 2nd
line drugs (angioedema & urticaria)
§ Decongestants - most OTC - are sympathomimetic
§ Steroids - 2nd line drugs
· Nasal sprays - beclomethasone, triamcinolone, fluticasone (limit 5 days
at a time)
