A nurse is educating a patient with systemic lupus erythematosus.
Which medication is commonly prescribed to manage SLE symptoms and decrease exacerbations?

Choice A rationale

Hypotension is typically not associated with this condition because the tumor hypersecretes catecholamines like epinephrine and norepinephrine. These substances induce potent vasoconstriction and increase systemic vascular resistance, leading to severe hypertension rather than low blood pressure. Patients often experience paroxysmal or sustained elevations in blood pressure that can exceed 200/110 mmHg. Therefore, hypotension would only occur in rare cases of catecholamine depletion or during specific medical crises.

Choice B rationale

Tachycardia is a classic manifestation resulting from the stimulatory effects of excessive catecholamines on cardiac beta-1 adrenergic receptors. This stimulation increases the heart rate and myocardial contractility significantly. The patient may report a racing heart or a rapid pulse even while at rest. This sympathetic overactivity is a hallmark of the clinical triad, which also includes headache and diaphoresis, and it requires careful monitoring to prevent potential cardiac complications or arrhythmias.

Choice C rationale

Headaches are one of the most common presenting symptoms and are usually described as severe, pounding, and sudden in onset. This occurs due to the acute and dramatic increase in systemic arterial blood pressure caused by the sudden release of catecholamines from the adrenal medulla or extra-adrenal chromaffin tissue. The resulting cerebral vasodilation and increased intracranial pressure contribute to the intense pain. It is often the symptom that prompts the patient to seek medical evaluation.

Choice D rationale

Weight gain is unlikely because the chronic excess of catecholamines increases the basal metabolic rate and promotes glycogenolysis and lipolysis. Most patients actually experience unexplained weight loss despite having a normal or increased appetite. The hypermetabolic state induced by the tumor mimics hyperthyroidism in some aspects, leading to increased energy expenditure. Therefore, significant weight gain would be an atypical finding and might suggest a different underlying metabolic or endocrine disorder.

Choice E rationale

Palpitations occur as a direct result of the chronotropic and inotropic effects of catecholamines on the myocardium. The patient becomes acutely aware of their heartbeat, which they often describe as a forceful thumping or fluttering in the chest. These episodes can occur spontaneously or be triggered by physical exertion, emotional stress, or pressure on the tumor. Palpitations are frequently accompanied by anxiety or a sense of impending doom during a catecholamine surge.

Choice F rationale

Tremors are caused by the overstimulation of the nervous system and skeletal muscles by circulating epinephrine and norepinephrine. This increased sympathetic tone leads to fine or coarse muscle tremors, often visible in the hands. The excessive stimulation of beta-2 receptors in the skeletal muscles contributes to this fine motor instability. Tremors are frequently associated with other signs of autonomic hyperactivity, such as diaphoresis and nervousness, forming part of the systemic response to the tumor.

Choice A rationale

Monitoring blood pressure is a necessary part of assessment, but it is not a therapeutic intervention that addresses the underlying life threatening hyperthermia. Waiting for further orders in the presence of a temperature of 40 C and confusion can lead to irreversible multi organ failure or death. The nurse must recognize the urgency of heat stroke symptoms and initiate independent nursing actions that prioritize rapid temperature reduction to protect the brain and other vital metabolic processes.

Choice B rationale

This client is exhibiting classic signs of heat stroke, which is a medical emergency characterized by a core temperature above 40 C and central nervous system dysfunction. Rapid cooling is the priority intervention to prevent permanent neurological damage and cardiovascular collapse. Techniques such as evaporative cooling, ice packs to the axilla and groin, or cold water immersion should be started immediately to bring the temperature down to a safer range, typically below 38.9 C (102 F).

Choice C rationale

Encouraging oral fluids is inappropriate for a client who is confused and potentially experiencing a decreased level of consciousness. This poses a significant aspiration risk. Furthermore, oral rehydration is insufficient to treat the extreme core temperature elevation seen in heat stroke. While hydration is part of the overall management, the immediate priority remains external and internal cooling measures that can lower the body temperature much faster than the metabolic process of fluid ingestion.

Choice D rationale

Antipyretics like acetaminophen or aspirin are ineffective in treating heat stroke or heat exhaustion. These medications work by resetting the hypothalamic set point, which is elevated during a true fever caused by pyrogens or infection. In environmental hyperthermia, the set point is normal but the body's thermoregulation is overwhelmed by external heat. Administering these drugs may also be harmful, as they can exacerbate coagulopathies or liver injury already present due to the severe heat stress.