A nurse is caring for a client who has systemic lupus erythematosus (SLE).
The client asks why she has to have her blood drawn so often.
Which of the following responses should the nurse make?
“We need to monitor your kidney function because SLE can cause glomerulonephritis.”
“We need to monitor your liver function because SLE can cause hepatic necrosis.”
“We need to monitor your thyroid function because SLE can cause hypothyroidism.”
“We need to monitor your pancreatic function because SLE can cause diabetes mellitus.”.
The Correct Answer is A
“We need to monitor your kidney function because SLE can cause glomerulonephritis.” Glomerulonephritis is kidney inflammation caused by SLE that can damage the filtering units of the kidneys called glomeruli. SLE is an autoimmune disease that can affect various organs and tissues, including the kidneys. About half of the people with lupus experience kidney involvement, which can lead to kidney failure if not treated.
Therefore, it is important to monitor the kidney function of people with SLE.
Choice B is wrong because SLE does not cause hepatic necrosis, which is the death of liver cells. SLE can cause inflammation of the liver, but this is less common and less severe than kidney involvement.
Choice C is wrong because SLE does not cause hypothyroidism, which is a condition where the thyroid gland does not produce enough thyroid hormones.
SLE can affect the thyroid gland, but this is rare and usually does not affect the thyroid function.
Choice D is wrong because SLE does not cause diabetes mellitus, which is a condition where the body cannot regulate blood sugar levels.
SLE can cause inflammation of the pancreas, but this is uncommon and usually does not affect the insulin production.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Discontinue the oxytocin (Pitocin) infusion.This is because the fetal heart rate (FHR) drops sharply from the baseline for 30 seconds during the peak of a contraction and then returns to the baseline before the end of the contraction indicate alate deceleration, which is a sign offetal hypoxia.Oxytocin is a drug that stimulates uterine contractions and can causeuterine hyperstimulation, which reduces blood flow to the placenta and the fetus.By stopping the oxytocin infusion, the nurse can reduce the frequency and intensity of contractions and improve fetal oxygenation.
Choice A is wrong because administering oxygen via facemask may not be enough to reverse fetal hypoxia if oxytocin is still being infused.Choice B is wrong because placing the client on her left side may improve maternal blood flow to the placenta, but it will not reduce the effects of oxytocin on uterine activity.
Choice D is wrong because notifying the healthcare provider is not the most urgent action at this time.The nurse should first discontinue the oxytocin infusion and then notify the healthcare provider.
Normal ranges for FHR are 110 to 160 beats per minute, with a baseline variability of 6 to 25 beats per minute.
Normal ranges for uterine contractions are 2 to 5 contractions in 10 minutes, lasting
Correct Answer is A
Explanation
This is because hypoglycemia in newborns can cause seizures, brain damage, and developmental delays, and frequent monitoring can help detect and correct low blood glucose levels promptly.
Some additional information about the other choices are:
Choice B. Administer glucagon subcutaneously as prescribed.This is wrong because glucagon is used to treat hypoglycemia caused by hyperinsulinism, which is a rare condition in newborns.Most cases of hypoglycemia in term infants are due to transient factors such as delayed feeding, maternal diabetes, or perinatal stress.
Choice C. Discontinue IV dextrose when blood glucose reaches 60 mg/dL.This is wrong because 60 mg/dL is still below the normal range of blood glucose for newborns, which is 70 to 100 mg/dL.Discontinuing IV dextrose too early can cause rebound hypoglycemia and increase the risk of neurologic complications.
Choice D. Feed breast milk or formula every four hours.This is wrong because feeding every four hours may not be enough to maintain adequate blood glucose levels in newborns with hypoglycemia.Infants with hypoglycemia should be fed more frequently, such as every two to three hours, or on demand.Breast milk or formula can also be supplemented with IV dextrose if needed.
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