A client who has a history of pericarditis reports experiencing a decrease in urinary output. While assessing the client, the nurse observes a dry, scaly raised rash on the face in a the shape of a butterfly and deformities on the joints of the hands. Based on these clinical signs and symptoms, which condition does the nurse suspect?

Rheumatoid arthritis.

Eczema.

Psoriasis.

Systemic lupus erythematosus (SLE).

Answer and Explanation

The Correct Answer is D

A. Rheumatoid arthritis (RA) primarily affects the joints, leading to pain, swelling, and deformities such as ulnar deviation or swan-neck deformities. While the client does have hand joint deformities, RA does not typically cause the characteristic facial rash described as a butterfly pattern. Therefore, RA alone does not fully explain the observed clinical presentation.

B. Eczema is a chronic inflammatory skin condition that causes dry, itchy, scaly patches. While the rash may resemble dryness or scaling, eczema does not present with the classic malar (butterfly-shaped) rash on the face, nor does it cause joint deformities or decreased urinary output. Thus, eczema is unlikely in this case.

C. Psoriasis can produce raised, scaly plaques on the skin and sometimes involve joint inflammation (psoriatic arthritis). However, the typical psoriatic rash does not follow the malar (butterfly) distribution on the face. Additionally, psoriasis does not typically cause pericarditis or kidney involvement, which may explain the decreased urinary output.

D. Systemic lupus erythematosus (SLE) is an autoimmune disorder that can affect multiple organ systems. In this client, the malar (butterfly) rash across the cheeks and nose is a classic cutaneous manifestation of SLE. The joint deformities, often non-erosive, involve small joints of the hands. The history of pericarditis represents a common cardiac manifestation of SLE. The decrease in urinary output suggests possible lupus nephritis, a renal complication of SLE. Taken together, these features strongly support a diagnosis of SLE, making option D the correct choice.

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Correct Answer is B

Explanation

A. A fundal height of 22 cm at 28 weeks gestation is below the expected measurement. Normally, fundal height in centimeters approximately matches the gestational age in weeks (±2 cm). At 28 weeks, the expected fundal height is about 26–30 cm. A measurement of 22 cm may indicate intrauterine growth restriction or inaccurate measurement, which warrants further assessment.

B. This is within normal limits. During pregnancy, maternal heart rate typically increases by 10–15 beats per minute due to increased blood volume and cardiac output. A 10-beat increase is physiologically expected and does not usually indicate pathology in a low-risk client.

C. Glucosuria (glucose in urine) is not considered normal and may suggest gestational diabetes. While trace amounts can sometimes be seen, persistent glucosuria requires follow-up testing and assessment.

D. Proteinuria (protein in urine) is abnormal in pregnancy and can be an early sign of preeclampsia or kidney dysfunction. Even small amounts are clinically significant and require evaluation.

A. Adequate sunlight. B. Cool, moist air. C. Quiet, calm surroundings. D. Stimulating sounds and activity.

Correct Answer is A

Explanation

A. This is the most significant factor because osteomalacia is caused by a deficiency of vitamin D, which is essential for calcium absorption and bone mineralization. Adequate sunlight exposure enables the skin to synthesize vitamin D naturally, which helps prevent further bone softening and promotes bone health. Ensuring the client has access to sunlight, while balancing skin protection, is a key environmental intervention.

B. Cool, moist air may affect comfort but has no direct effect on bone metabolism or vitamin D synthesis. While environmental comfort is important, it is not the primary concern in managing osteomalacia.

C. Quiet, calm surroundings can reduce stress and promote rest, which is supportive care. However, stress reduction does not directly influence bone mineralization or vitamin D status.

D. Stimulating sounds and activity may promote alertness or engagement but are not relevant to the pathophysiology or treatment of osteomalacia. Excessive activity without adequate bone strength could even increase the risk of fractures.

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Naxlex Comprehensive Predictor Exams

A low-risk primigravida at 28-weeks gestation arrives for her regular antepartal clinic visit. Which assessment finding should the nurse consider within normal limits for this client?

Correct Answer is B

Explanation

Which environmental factor is most significant when planning care for a client with osteomalacia?

Correct Answer is A

Explanation

Chart is reviewed. Choose the most likely options for the information missing from the statement by selecting from the lists of options provided. The client is most at risk for dropdownevidenced by dropdown

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An adult client who had a gastric bypass two days ago reports to the nurse of feeling bloated. After verifying that the client's abdomen is distended, which intervention should the nurse implement?

The nurse is evaluating the effectiveness of the incentive spirometer implemented in the client's plan of care. Which outcome statement best describes the effectiveness of the incentive spirometer?

Fifteen minutes after receiving sulfamethoxazole-trimethoprim (SMZ-TMP), the client reports a burning sensation over the abdomen, chest, and groin. Which intervention is most important for the nurse to implement?

A client reports bloating and abdominal cramps after eating ice cream and foods with cheese. Which condition should the nurse suspect?

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