A clinic nurse is performing a physical assessment on a client who has systemic lupus erythematosus (SLE). Which of the following findings should the nurse expect?

Choice A rationale:
Phenytoin is an anticonvulsant medication that is typically used long-term to control seizures. It is not a medication that can be stopped abruptly, as this can lead to the recurrence of seizures or even status epilepticus, a life-threatening condition characterized by continuous seizure activity.
The client's statement, "I'll be glad when I can stop taking this medicine," indicates a lack of understanding about the long- term nature of phenytoin therapy and the potential risks associated with stopping the medication prematurely.
Further teaching is needed to emphasize the importance of medication adherence and the potential consequences of non- adherence.

Choice B rationale:
Phenytoin can cause gingival hyperplasia (overgrowth of gum tissue), so it is important for clients taking this medication to see a dentist regularly for checkups and cleanings.
The client's statement, "I have made an appointment to see my dentist next week," indicates an understanding of this potential side effect and the need for regular dental care.

Choice C rationale:
Phenytoin has a narrow therapeutic index, meaning that there is a small difference between the effective dose and the toxic dose.
Switching brands of phenytoin can lead to changes in blood levels of the medication, which could potentially result in therapeutic failure or toxicity.
The client's statement, "I know that I cannot switch brands of this medication," indicates an understanding of this important safety consideration.

Choice D rationale:
Phenytoin can interact with many other medications, including over-the-counter medications and herbal supplements.
It is important for clients taking phenytoin to notify their doctor before taking any other medications to avoid potential drug interactions.
The client's statement, "I will notify my doctor before taking any other medications," indicates an understanding of this potential risk.

Choice A rationale:
Pitting edema of the hands and fingers is not a typical finding in SLE. It can occur in some cases, but it is more commonly associated with other conditions such as kidney disease or heart failure.

Choice B rationale:
Grey colored, non-purpuric papular rash is not a characteristic of SLE. This type of rash is more commonly seen in conditions such as lichen planus or sarcoidosis.

Choice C rationale:
A dry, red rash across the bridge of the nose and on the cheeks, also known as a malar rash, is a classic sign of SLE. It is often described as a "butterfly rash" because of its shape. The rash is caused by inflammation of the small blood vessels in the skin. It is typically worsened by sun exposure.

Choice D rationale:
Subcutaneous nodules on the ulnar side of the arm are a characteristic finding in rheumatoid arthritis, not SLE.