A nurse is assessing a patient who has systemic lupus erythematosus (SLE). Which of the following findings is the highest priority for the nurse to report to the provider?
Presence of peripheral edema.
Joint pain in hands and knees.
Dry, raised rash on the face.
Patient reports feelings of depression.
The Correct Answer is A
The correct answer is Choice A
Choice A rationale: Peripheral edema in a patient with systemic lupus erythematosus may indicate lupus nephritis, a serious complication involving immune complex deposition in the glomeruli. This leads to proteinuria, hypoalbuminemia, and fluid retention. Normal serum albumin ranges from 3.5–5.0 g/dL; levels below this promote third spacing and edema. Kidney involvement is a major cause of morbidity and mortality in SLE. Early detection is critical to prevent progression to renal failure, making this the highest priority finding.
Choice B rationale: Joint pain is a common manifestation of SLE due to inflammatory synovitis. It typically affects small joints symmetrically and is non-erosive. While it contributes to morbidity, it is not life-threatening and does not indicate organ damage. Inflammatory markers like ESR and CRP may be elevated, but they do not correlate with disease severity. Pain management and anti-inflammatory therapy are important, but joint pain alone does not warrant urgent provider notification compared to renal signs.
Choice C rationale: The classic malar rash in SLE is dry, raised, and erythematous, often sparing the nasolabial folds. It reflects cutaneous involvement and photosensitivity due to autoantibody-mediated inflammation. While it aids diagnosis, it is not an acute threat to organ function. Skin lesions may be managed with topical corticosteroids and sun protection. Dermatologic findings are common but not emergent unless associated with systemic symptoms like fever, vasculitis, or bullous eruptions. Thus, it is not the priority.
Choice D rationale: Depression is a significant concern in chronic autoimmune diseases due to psychosocial stress, fatigue, and neuropsychiatric lupus. However, unless accompanied by suicidal ideation or psychosis, it is not the most urgent issue. Neuropsychiatric lupus may present with seizures, psychosis, or cognitive dysfunction, which require immediate attention. Feelings of depression should be addressed through mental health support and screening, but they do not surpass the urgency of renal involvement indicated by peripheral edema
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Limiting fluid intake to 1L each day is generally not recommended for individuals with irritable bowel syndrome (IBS) unless specifically indicated due to other co-existing conditions. Adequate hydration is important for overall health and can help prevent constipation, a common symptom of IBS. General recommendations for fluid intake are around 2-3 liters per day, depending on individual needs and activity levels.
Choice B rationale
Keeping a food diary is a valuable strategy for individuals with irritable bowel syndrome (IBS) to identify specific food triggers that exacerbate their symptoms such as abdominal pain, bloating, diarrhea, or constipation. By meticulously recording food intake and associated symptoms, patients can often discern patterns and work with healthcare providers to develop an individualized dietary management plan.
Choice C rationale
Planning three moderate to large meals per day might not be suitable for all individuals with irritable bowel syndrome (IBS). Some people with IBS find that smaller, more frequent meals are better tolerated as large meals can distend the bowel and trigger symptoms. Individual responses to meal size and frequency can vary significantly.
Choice D rationale
While fiber is generally beneficial for bowel regularity, a blanket recommendation of 12 to 20g of fiber daily might not be appropriate for all individuals with irritable bowel syndrome (IBS). For some individuals, particularly those with diarrhea-predominant IBS, increasing fiber intake too quickly or consuming certain types of high-fiber foods can worsen their symptoms. Fiber intake should be individualized and often increased gradually.
Correct Answer is D
Explanation
Choice A rationale
Stretching exercises primarily improve flexibility and range of motion by elongating muscles and connective tissues. While beneficial for overall fitness, they do not directly address bone density loss, which is the primary concern in osteoporosis. Osteoporosis requires weight-bearing activities to stimulate bone formation.
Choice B rationale
Riding a bicycle is a low-impact aerobic exercise that improves cardiovascular health and muscle strength. However, because it is non-weight-bearing, it does not provide the mechanical stress necessary to promote bone density and is therefore not the most effective exercise for osteoporosis management.
Choice C rationale
High-impact aerobics, such as jumping and running, can increase the risk of fractures in individuals with osteoporosis due to the stress placed on weakened bones. These types of exercises should generally be avoided to prevent injury.
Choice D rationale
Walking briskly is a weight-bearing exercise that applies moderate stress to the bones, stimulating osteoblast activity and promoting bone density. Regular brisk walking can help slow bone loss and reduce the risk of fractures in older adults with osteoporosis.
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