A nurse is caring for a pregnant patient with systemic lupus erythematosus (SLE) who is concerned about the potential effects on her pregnancy.

Which of the following information should the nurse emphasize when discussing management strategies for this patient?

Choice A rationale

Pain assessment is a standard component of holistic nursing care, particularly for clients with systemic lupus erythematosus who often experience chronic joint inflammation and vasculitis. However, during the specific context of plasmapheresis, pain is not the most life-threatening or physiologically critical parameter compared to hematological stability. While documenting a management plan is necessary for comfort, it does not directly mitigate the immediate procedural risks of hemorrhage or severe transfusion-related reactions associated with the apheresis process.

Choice B rationale

Reviewing dietary intake is relevant for assessing the nutritional status of a client with a chronic autoimmune condition, as systemic lupus erythematosus can lead to protein-losing enteropathy or renal complications. Nevertheless, a 24-hour food recall does not provide real-time data regarding the client's current physiological readiness for an extracorporeal procedure. Plasmapheresis involves significant fluid shifts and the removal of plasma proteins, making recent nutritional intake secondary to the critical objective data found in current laboratory values.

Choice C rationale

Inquiring about allergies to contrast media is vital before radiological studies like CT scans or angiographies that utilize iodine-based dyes. However, plasmapheresis does not typically involve the administration of contrast media. The primary allergic concerns during this procedure relate to the replacement fluids used, such as albumin or fresh frozen plasma, rather than radiopaque contrast. Therefore, while maintaining an allergy history is important for general safety, it is not the priority assessment for this specific intervention.

Choice D rationale

Evaluating the complete blood count is the highest priority because plasmapheresis involves the extracorporeal separation of blood components. The nurse must assess the platelet count, as levels below 150,000/mm increase the risk of procedural bleeding. Additionally, checking the hemoglobin (normal 12 to 16 g/dL for females, 14 to 18 g/dL for males) and hematocrit (normal 37.

Choice A rationale

Tumor lysis syndrome is an oncologic emergency characterized by the rapid release of intracellular contents, including potassium, phosphate, and nucleic acids, into the bloodstream. These nucleic acids are metabolized into uric acid, which can precipitate in the renal tubules, leading to obstructive uropathy and acute kidney injury. Aggressive hydration, typically 3 liters or more daily, is the primary intervention to increase urine flow, dilute the concentration of these substances, and promote their renal excretion.

Choice B rationale

The semi-Fowler's position is primarily utilized to improve lung expansion and decrease the work of breathing in patients with respiratory distress or to prevent aspiration. While comfortable, it does not directly address the underlying pathophysiology of tumor lysis syndrome or the prevention of acute kidney injury. The priority in this metabolic emergency is maintaining high intravascular volume and renal perfusion to clear the excessive load of electrolytes and uric acid produced by the rapidly lysing malignant cells.

Choice C rationale

Obtaining blood cultures is a standard intervention for suspected sepsis or systemic infection but is not a primary treatment for tumor lysis syndrome. While oncology patients are often immunocompromised and at risk for infection, the immediate threat in tumor lysis syndrome is metabolic derangement and renal failure. Nurses should focus on monitoring electrolyte levels, such as potassium (normal 3.5 to 5.0 mEq/L) and phosphorus (normal 2.5 to 4.5 mg/dL), and ensuring aggressive fluid resuscitation rather than diagnostic tests for infection.

Choice D rationale

High-dose intravenous corticosteroids are not the standard treatment for preventing acute kidney injury in the context of tumor lysis syndrome. While steroids may be part of the chemotherapy regimen that initially triggered the cell lysis, the management of the resulting syndrome involves hydration, allopurinol or rasburicase to lower uric acid levels, and the management of electrolyte imbalances. Corticosteroids do not assist in the clearance of uric acid or the protection of renal tubules from metabolic crystalline deposits. .