A nurse is providing client education to a client that has been recently diagnosed with systemic lupus erythematosus (SLE). The nurse would include what important fact that is thought to be a trigger for a flare-up?
Avoid foods that are rich in purines because it will trigger your lupus.
Limit sun exposure, wear sunscreen, and protective clothing outdoors.
Protect your finger joints by not wringing out wet washcloths or towels.
Consider activity and rest periods to decrease joint pain.
The Correct Answer is B
Choice A rationale
Purine rich foods like organ meats and seafood are typically restricted in patients with gout because they break down into uric acid, leading to crystal deposition in joints. Systemic lupus erythematosus is an autoimmune connective tissue disorder, not a metabolic disorder of uric acid. While a healthy diet is recommended, purines are not recognized as a primary trigger for lupus flares. Nutritional education for lupus focuses more on overall balance rather than specific purine avoidance.
Choice B rationale
Photosensitivity is a classic feature of systemic lupus erythematosus, affecting approximately 60 to 70 percent of patients. Ultraviolet light exposure can trigger both cutaneous lesions and systemic disease exacerbations by inducing keratinocyte apoptosis and increasing autoantibody production. Clients must be educated to use broad spectrum sunscreen with a high sun protection factor, wear wide brimmed hats, and seek shade. Managing UV exposure is the most critical lifestyle intervention for preventing painful and dangerous disease flares.
Choice C rationale
Avoiding wringing out wet cloths is an energy conservation and joint protection technique primarily taught to patients with rheumatoid arthritis to prevent ulnar drift and joint deformity. While lupus can cause joint pain and inflammation, the primary concern for a flare-up is systemic organ involvement triggered by environmental factors. Protecting joints is beneficial for comfort, but it does not address the underlying physiological triggers that cause the immune system to become hyperactive in a lupus flare.
Choice D rationale
Balancing activity with rest is an essential self-care strategy for managing the chronic fatigue and arthralgia associated with systemic lupus erythematosus. Proper pacing helps maintain functional status and reduces the physical stress that can contribute to overall malaise. However, while rest helps manage symptoms, a lack of rest is generally considered a secondary factor compared to the direct immune system provocation caused by ultraviolet radiation. Choice B remains the priority for flare-up prevention education.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Mydriatics are agents used to dilate the pupils by stimulating the iris dilator muscle or paralyzing the sphincter muscle. These medications are strictly contraindicated in most glaucoma patients, particularly those with narrow-angle glaucoma. Dilation of the pupil can bunch up the iris tissue in the drainage angle, blocking the outflow of aqueous humor. This obstruction causes a rapid increase in intraocular pressure, which can lead to permanent optic nerve damage and blindness.
Choice B rationale
Antifungal medications are utilized to treat ocular infections caused by various fungi, such as keratitis or endophthalmitis. Glaucoma is a chronic, non-infectious neurodegenerative condition characterized by elevated intraocular pressure rather than a microbial invasion. Therefore, antifungals do not address the underlying pathophysiology of aqueous humor production or drainage. Their use in a glaucoma treatment plan would be inappropriate unless a secondary fungal infection was specifically diagnosed by the provider.
Choice C rationale
Beta blockers are frequently used to treat glaucoma by reducing the production of aqueous humor by the ciliary body. While they are common, the question asks for a medication that is traditionally a cornerstone of lifelong management alongside others. Beta blockers work by blocking beta-adrenergic receptors in the eye. However, they carry systemic risks, such as bradycardia and bronchospasm, which may limit their use in patients with certain cardiac or respiratory conditions compared to other options.
Choice D rationale
Miotics, such as pilocarpine, are essential for lifelong glaucoma management because they cause pupillary constriction. By contracting the ciliary muscle, these agents increase the outflow of aqueous humor through the trabecular meshwork. This physical opening of the drainage pathways is vital for maintaining intraocular pressure within the safe range of 10 to 21 mmHg. Consistent use of miotics helps prevent the progressive optic nerve atrophy that defines the disease and leads to vision loss.
Correct Answer is D
Explanation
Choice A rationale
Seeing distant objects better than close ones is a sign of hyperopia, or farsightedness, rather than glaucoma. In hyperopia, the light focuses behind the retina instead of on it. While this involves a change in visual acuity, it does not relate to the increased intraocular pressure or optic nerve damage seen in glaucoma. Glaucoma primarily affects peripheral vision first, leaving central vision intact until the advanced stages.
Choice B rationale
Tearing and itching are characteristic symptoms of allergic conjunctivitis or dry eye syndrome. These symptoms are caused by environmental irritants or an inflammatory response on the ocular surface. They do not indicate the internal pathological changes associated with glaucoma. Glaucoma is often a silent disease that progresses without surface irritation, making regular intraocular pressure screenings essential for early detection and prevention of permanent vision loss.
Choice C rationale
Difficulty matching colors, particularly blue and yellow, is often associated with the formation of cataracts or certain types of retinal disease. As the lens yellows with age or opacities develop, color perception can be significantly altered. While glaucoma can eventually affect color vision as the optic nerve sustains damage, it is not the hallmark early symptom reported by clients. Color vision deficits are more indicative of lens or retinal issues.
Choice D rationale
Seeing halos around lights and experiencing peripheral vision loss are classic signs of glaucoma. Increased intraocular pressure, often exceeding the normal range of 10 to 21 mmHg, causes damage to the optic nerve fibers. This damage manifests as tunnel vision, where the client can see straight ahead but loses the ability to see objects or people to the side. The perception of halos is frequently associated with acute angle-closure episodes.
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