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

A grey colored, non-purpuric papular rash.

Subcutaneous nodules on the ulnar side of the arm.

A dry, red rash across the bridge of the nose and on the cheeks.

Pitting edema of the hands and fingers.

Answer and Explanation

The Correct Answer is C

Choice A rationale

A grey colored, non-purpuric papular rash is not a typical dermatological manifestation of systemic lupus erythematosus. SLE is often associated with erythematous rashes due to inflammation and immune complex deposition in the skin. Purpura indicates bleeding under the skin, which is not characteristic of the lupus rash.

Choice B rationale

Subcutaneous nodules on the ulnar side of the arm are more commonly associated with rheumatoid arthritis or gout, not systemic lupus erythematosus. SLE primarily affects connective tissues and can cause various skin manifestations, but subcutaneous nodules are not a hallmark finding.

Choice C rationale

A dry, red rash across the bridge of the nose and on the cheeks, often described as a "butterfly rash" or malar rash, is a classic and highly specific finding in patients with systemic lupus erythematosus. This rash is caused by photosensitivity and inflammation in the facial skin.

Choice D rationale

Pitting edema of the hands and fingers is not a primary finding directly associated with systemic lupus erythematosus. While SLE can cause renal involvement leading to fluid retention and edema, localized pitting edema in the hands and fingers is less typical and might suggest other underlying conditions.

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Correct Answer is A

Explanation

Choice A rationale

Basal cell carcinoma, the most common type of skin cancer, often presents as a raised, flesh-colored or pearly white papule or nodule with rolled, pearly borders and telangiectasia (visible small blood vessels). The description of the 1-cm raised, flesh-colored lesion with pearly white borders aligns with the typical appearance of basal cell carcinoma.

Choice B rationale

Malignant melanoma is characterized by its irregular shape, asymmetrical borders, uneven color (often with shades of black, brown, red, white, or blue), and diameter greater than 6 mm. It can arise from existing moles or appear as a new pigmented lesion. The described lesion does not fit this profile.

Choice C rationale

Actinic keratosis is a precancerous skin condition that appears as rough, scaly patches on sun-exposed areas. These lesions are typically flat or slightly raised and can be skin-colored, reddish-brown, or have a whitish scale. The description of a raised lesion with pearly borders is inconsistent with actinic keratosis.

Choice D rationale

Squamous cell carcinoma often presents as a firm, red nodule or a flat lesion with a scaly, crusted surface. It can also appear as a non-healing ulcer. While it can occur on the chest, the pearly white borders are more characteristic of basal cell carcinoma.

A. Decrease fluid intake. B. Offer the client the bedpan every 2 hr. C. Increase protein intake. D. Increase ambulation.

Correct Answer is D

Explanation

Choice A rationale

Decreasing fluid intake can lead to dehydration and constipation, which would further impede peristalsis rather than promote it. Adequate hydration is essential for maintaining bowel regularity and facilitating the movement of intestinal contents.

Choice B rationale

Offering the bedpan every 2 hours does not directly stimulate peristalsis. While it provides an opportunity for bowel elimination, it does not address the underlying issue of decreased intestinal motility associated with paralytic ileus.

Choice C rationale

Increasing protein intake does not directly promote peristalsis. While protein is important for overall healing, it does not have a significant impact on stimulating bowel motility. Fiber intake is more directly related to promoting bowel function.

Choice D rationale

Increased ambulation stimulates peristalsis by promoting intestinal motility. Physical activity helps to move gas and fluids through the intestines, reducing the risk of paralytic ileus, which is a functional obstruction of the bowel often occurring after surgery.

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

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

During a routine physical examination, a nurse observes a 1-cm (0.4-in) lesion on a client's chest.The lesion is raised and flesh-colored with pearly white borders.The nurse should recognize that this finding is suggestive of which of the following types of skin cancer?

Correct Answer is A

Explanation

A nurse is planning care for a client who is postoperative and at risk for paralytic ileus.Which of the following interventions should the nurse plan to take to promote peristalsis?

Correct Answer is D

Explanation

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During a routine physical examination, a nurse observes a 1-cm (0.4-in) lesion on a client's chest.The lesion is raised and flesh-colored with pearly white borders.The nurse should recognize that this finding is suggestive of which of the following types of skin cancer?

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