MS1 (RLE) – P3 EXAMINATION
1. A 26-year-old woman has been diagnosed with early systemic lupus
erythematosus (SLE) involving her joints. In teaching the patient about the
disease, the nurse includes the information that SLE is a(n):
A. Hereditary disorder of women in which antibodies are formed that
destroy all nucleated cells in the body.
B. Autoimmune disease of women in which antibodies are formed that
destroy all nucleated cells in the body.
C. Disorder of immune function, but it is extremely variable in its course,
and there is no way to predict its progression.
D. Disease that causes production of antibodies that bind with cellular
estrogen receptors, causing an inflammatory response.
Rationale: Systemic lupus erythematosus (SLE) is a chronic autoimmune
disease that is highly variable in its presentation and progression. It
involves the immune system attacking its own tissues, leading to
inflammation. There is no way to predict the course of SLE as it varies
widely between individuals.
2. A patient with an acute exacerbation of systemic lupus erythematosus
(SLE) is hospitalized with incapacitating fatigue, weak hand and wrist pain,
and proteinuria. The health care provider prescribes prednisone (Deltasone)
40 mg twice daily. Which nursing action should be included in the plan of
care?
A. Institute seizure precautions.
B. Monitor intake and output.
C. Monitor bedtime and place PRN.
D. Place on cardiac monitor.
Rationale: Prednisone, a corticosteroid, can cause fluid retention, weight
gain, and changes in electrolyte balance. Monitoring intake and output helps
assess kidney function and prevent complications such as fluid overload and
worsening of the patient's condition.
3. A patient with systemic lupus erythematosus (SLE) who has a facial rash
and alopecia tells the nurse, "I hate the way I look! I never go anywhere
except here to the hospital." An appropriate nursing diagnosis for the
patient is:
,A. Activity intolerance related to fatigue and inactivity.
B. Impaired skin integrity related to itching and skin sloughing.
C. Social isolation related to embarrassment about the effects of SLE.
D. Impaired social interaction related to lack of social skills.
Rationale: The patient expresses emotional distress about her appearance
due to facial rash and alopecia, which is common in SLE. Social isolation
due to embarrassment is a relevant nursing diagnosis in this situation.
4. A patient with polyarthralgia with joint swelling and pain is being
evaluated for systemic lupus erythematosus (SLE). The nurse knows that
the serum test result that is the most specific for SLE is the presence of:
A. Rheumatoid factor (RF).
B. Anti-Smith antibody (Anti-Sm).
C. Antinuclear antibody (ANA).
D. Lupus erythematosus (LE) cell prep.
Rationale: The presence of Anti-Smith (Anti-Sm) antibodies is highly
specific for SLE, even though it is found in only about 20-30% of patients.
Other tests like antinuclear antibodies (ANA) are more sensitive but less
specific.
5. Following instruction for a patient with newly diagnosed systemic lupus
erythematosus (SLE), the nurse determines that teaching about the disease
has been effective when the patient says:
A. "I should expect to have a low fever all the time with this disease."
B. "I need to restrict my exposure to sunlight to prevent an acute onset of
symptoms."
C. "I should try to ignore my symptoms as much as possible and have a
positive outlook."
D. "I can expect a temporary improvement in my symptoms if I become
pregnant."
Rationale: Photosensitivity is common in SLE, and sunlight exposure can
exacerbate the disease and trigger flare-ups. Educating patients to limit sun
exposure is important in managing SLE.
,6. A 19-year-old patient who is taking azathioprine (Imuran) for systemic
lupus erythematosus has a check-up before leaving home for college. The
health care provider writes all of these orders. Which one should the nurse
question?
A. Naproxen (Aleve) 200 mg BID
B. Give measles-mumps-rubella (MMR) immunization
C. Draw anti-DNA titer
D. Famotidine (Pepcid) 20 mg daily
Rationale: Live vaccines, such as the MMR vaccine, are generally
contraindicated in patients on immunosuppressive drugs like azathioprine
because of the risk of developing infections. The nurse should question this
order.
7. A client is suspected of having systemic lupus erythematosus. The nurse
monitors the client, knowing that which of the following is one of the initial
characteristic signs of systemic lupus erythematosus?
A. Weight gain
B. Subnormal temperature
C. Elevated red blood cell count
D. Rash on the face across the bridge of the nose
Rationale: The classic "butterfly" rash across the cheeks and the bridge of
the nose is one of the hallmark signs of SLE. This is often one of the first
noticeable symptoms and is characteristic of the disease.
8. The nurse is assigned to care for a client with systemic lupus
erythematosus (SLE). The nurse plans care knowing that this disorder is:
A. A local rash that occurs as a result of allergy
B. A disease caused by overexposure to sunlight
C. An inflammatory disease of collagen contained in connective tissue
D. A disease caused by the continuous release of histamine in the body
Rationale: SLE is an autoimmune disease that leads to inflammation in
connective tissues, affecting joints, skin, kidneys, and other organs due to
an abnormal immune response.
, 9. The nurse is assigned to care for a client admitted to the hospital with a
diagnosis of systemic lupus erythematosus (SLE). The nurse reviews the
health care provider's prescriptions. Which of the following medications
would the nurse expect to be prescribed?
A. Antibiotic
B. Antidiarrheal
C. Corticosteroid
D. Opioid analgesic
Rationale: Corticosteroids like prednisone are commonly prescribed to
control inflammation and suppress the immune response in patients with
SLE. They help reduce symptoms and prevent flare-ups.
10. A nurse is collecting data on a client who complains of fatigue,
weakness, malaise, muscle pain, joint pain at multiple sites, anorexia, and
photosensitivity. Systemic lupus erythematosus (SLE) is suspected. The
nurse further checks for which of the following that is also indicative of the
presence of SLE?
A. Emboli
B. Ascites
C. Two hemoglobin S genes
D. Butterfly rash on cheeks and bridge of nose
Rationale: A butterfly-shaped rash over the cheeks and nose is a common
diagnostic feature of SLE. Other symptoms listed, such as fatigue, malaise,
muscle pain, and joint pain, are also indicative of SLE.
11. A client is noted to have a type I (IgE-mediated) hypersensitivity
reaction with a systemic response. The following are clinical manifestations
the nurse should anticipate, EXCEPT:
A. Allergic rhinitis
B. Stridor
C. Wheezing
D. Urticaria
E. Hypotension
Rationale: Allergic rhinitis is a localized manifestation of a type I
hypersensitivity reaction, not systemic. Systemic manifestations of IgE-
1. A 26-year-old woman has been diagnosed with early systemic lupus
erythematosus (SLE) involving her joints. In teaching the patient about the
disease, the nurse includes the information that SLE is a(n):
A. Hereditary disorder of women in which antibodies are formed that
destroy all nucleated cells in the body.
B. Autoimmune disease of women in which antibodies are formed that
destroy all nucleated cells in the body.
C. Disorder of immune function, but it is extremely variable in its course,
and there is no way to predict its progression.
D. Disease that causes production of antibodies that bind with cellular
estrogen receptors, causing an inflammatory response.
Rationale: Systemic lupus erythematosus (SLE) is a chronic autoimmune
disease that is highly variable in its presentation and progression. It
involves the immune system attacking its own tissues, leading to
inflammation. There is no way to predict the course of SLE as it varies
widely between individuals.
2. A patient with an acute exacerbation of systemic lupus erythematosus
(SLE) is hospitalized with incapacitating fatigue, weak hand and wrist pain,
and proteinuria. The health care provider prescribes prednisone (Deltasone)
40 mg twice daily. Which nursing action should be included in the plan of
care?
A. Institute seizure precautions.
B. Monitor intake and output.
C. Monitor bedtime and place PRN.
D. Place on cardiac monitor.
Rationale: Prednisone, a corticosteroid, can cause fluid retention, weight
gain, and changes in electrolyte balance. Monitoring intake and output helps
assess kidney function and prevent complications such as fluid overload and
worsening of the patient's condition.
3. A patient with systemic lupus erythematosus (SLE) who has a facial rash
and alopecia tells the nurse, "I hate the way I look! I never go anywhere
except here to the hospital." An appropriate nursing diagnosis for the
patient is:
,A. Activity intolerance related to fatigue and inactivity.
B. Impaired skin integrity related to itching and skin sloughing.
C. Social isolation related to embarrassment about the effects of SLE.
D. Impaired social interaction related to lack of social skills.
Rationale: The patient expresses emotional distress about her appearance
due to facial rash and alopecia, which is common in SLE. Social isolation
due to embarrassment is a relevant nursing diagnosis in this situation.
4. A patient with polyarthralgia with joint swelling and pain is being
evaluated for systemic lupus erythematosus (SLE). The nurse knows that
the serum test result that is the most specific for SLE is the presence of:
A. Rheumatoid factor (RF).
B. Anti-Smith antibody (Anti-Sm).
C. Antinuclear antibody (ANA).
D. Lupus erythematosus (LE) cell prep.
Rationale: The presence of Anti-Smith (Anti-Sm) antibodies is highly
specific for SLE, even though it is found in only about 20-30% of patients.
Other tests like antinuclear antibodies (ANA) are more sensitive but less
specific.
5. Following instruction for a patient with newly diagnosed systemic lupus
erythematosus (SLE), the nurse determines that teaching about the disease
has been effective when the patient says:
A. "I should expect to have a low fever all the time with this disease."
B. "I need to restrict my exposure to sunlight to prevent an acute onset of
symptoms."
C. "I should try to ignore my symptoms as much as possible and have a
positive outlook."
D. "I can expect a temporary improvement in my symptoms if I become
pregnant."
Rationale: Photosensitivity is common in SLE, and sunlight exposure can
exacerbate the disease and trigger flare-ups. Educating patients to limit sun
exposure is important in managing SLE.
,6. A 19-year-old patient who is taking azathioprine (Imuran) for systemic
lupus erythematosus has a check-up before leaving home for college. The
health care provider writes all of these orders. Which one should the nurse
question?
A. Naproxen (Aleve) 200 mg BID
B. Give measles-mumps-rubella (MMR) immunization
C. Draw anti-DNA titer
D. Famotidine (Pepcid) 20 mg daily
Rationale: Live vaccines, such as the MMR vaccine, are generally
contraindicated in patients on immunosuppressive drugs like azathioprine
because of the risk of developing infections. The nurse should question this
order.
7. A client is suspected of having systemic lupus erythematosus. The nurse
monitors the client, knowing that which of the following is one of the initial
characteristic signs of systemic lupus erythematosus?
A. Weight gain
B. Subnormal temperature
C. Elevated red blood cell count
D. Rash on the face across the bridge of the nose
Rationale: The classic "butterfly" rash across the cheeks and the bridge of
the nose is one of the hallmark signs of SLE. This is often one of the first
noticeable symptoms and is characteristic of the disease.
8. The nurse is assigned to care for a client with systemic lupus
erythematosus (SLE). The nurse plans care knowing that this disorder is:
A. A local rash that occurs as a result of allergy
B. A disease caused by overexposure to sunlight
C. An inflammatory disease of collagen contained in connective tissue
D. A disease caused by the continuous release of histamine in the body
Rationale: SLE is an autoimmune disease that leads to inflammation in
connective tissues, affecting joints, skin, kidneys, and other organs due to
an abnormal immune response.
, 9. The nurse is assigned to care for a client admitted to the hospital with a
diagnosis of systemic lupus erythematosus (SLE). The nurse reviews the
health care provider's prescriptions. Which of the following medications
would the nurse expect to be prescribed?
A. Antibiotic
B. Antidiarrheal
C. Corticosteroid
D. Opioid analgesic
Rationale: Corticosteroids like prednisone are commonly prescribed to
control inflammation and suppress the immune response in patients with
SLE. They help reduce symptoms and prevent flare-ups.
10. A nurse is collecting data on a client who complains of fatigue,
weakness, malaise, muscle pain, joint pain at multiple sites, anorexia, and
photosensitivity. Systemic lupus erythematosus (SLE) is suspected. The
nurse further checks for which of the following that is also indicative of the
presence of SLE?
A. Emboli
B. Ascites
C. Two hemoglobin S genes
D. Butterfly rash on cheeks and bridge of nose
Rationale: A butterfly-shaped rash over the cheeks and nose is a common
diagnostic feature of SLE. Other symptoms listed, such as fatigue, malaise,
muscle pain, and joint pain, are also indicative of SLE.
11. A client is noted to have a type I (IgE-mediated) hypersensitivity
reaction with a systemic response. The following are clinical manifestations
the nurse should anticipate, EXCEPT:
A. Allergic rhinitis
B. Stridor
C. Wheezing
D. Urticaria
E. Hypotension
Rationale: Allergic rhinitis is a localized manifestation of a type I
hypersensitivity reaction, not systemic. Systemic manifestations of IgE-
