A nurse is providing education to a client who has discoid lupus erythematosus.
Which of the following statements made by the client indicates understanding of how to prevent exacerbation of skin rashes?
"I must wash my hands before touching my skin.”.
"I need to apply sunscreen.”.
"I should exercise on a regular basis.”.
"I need to sleep 8 hours a night.”.
The Correct Answer is B
Choice A rationale
Washing hands before touching skin is a fundamental practice for infection control, preventing the introduction of pathogens to compromised skin. While essential for overall hygiene, it is not the primary action specifically targeted at preventing the exacerbation (flare-up) of the photosensitive rash characteristic of discoid lupus erythematosus.
Choice B rationale
Discoid lupus erythematosus (DLE) is a chronic inflammatory disorder where photosensitivity is a major trigger for the characteristic skin lesions. Ultraviolet (UV) radiation, from the sun or tanning beds, directly damages keratinocytes, which then express autoantigens and trigger an inflammatory, autoimmune response. Applying broad-spectrum sunscreen blocks this UV radiation, preventing the cellular damage and subsequent rash exacerbation.
Choice C rationale
Regular exercise promotes general health, improves circulation, and reduces stress, which may indirectly support the immune system. However, exercise is not the specific, direct, or primary intervention required to shield the skin from the known environmental trigger of UV radiation that causes flare-ups of discoid lupus lesions.
Choice D rationale
Adequate sleep, typically 7-9 hours for adults, supports general immune function and physical restoration. While important for managing any chronic illness, it does not offer direct, specific photoprotection or block the ultraviolet exposure that is the major, direct, and well-established physical trigger for the cutaneous inflammation characteristic of DLE.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Serum sodium is an electrolyte primarily reflecting fluid status and aldosterone/antidiuretic hormone (ADH) regulation, not specific renal filtration capacity. The normal range is 135-145 mEq/L. While severe renal impairment can cause hyponatremia due to impaired water excretion, it is not the most reliable standalone indicator of overall glomerular function.
Choice B rationale
Urine-specific gravity reflects the kidney's concentrating and diluting ability, which can be affected by volume status and tubular function. The normal range is 1.005-1.030. Although it's abnormal in severe tubular damage, it's a less specific measure of the crucial glomerular filtration rate (GFR), which is typically compromised first in lupus nephritis.
Choice C rationale
Serum creatinine is a metabolic waste product of muscle catabolism that is almost entirely filtered by the glomeruli and is the most widely used measure for estimating GFR and detecting renal damage. A normal value is 0.5-1.2 mg/dL. Elevated levels are the most specific and sensitive marker for acute or chronic renal function decline in conditions like lupus nephritis.
Choice D rationale
Blood urea nitrogen (BUN) reflects the concentration of urea in the blood. The normal range is 10-20 mg/dL. While elevated in renal failure, BUN is less specific than creatinine because it is also highly influenced by hydration status, gastrointestinal bleeding, and protein intake, causing variations independent of GFR.
Correct Answer is A
Explanation
Choice A rationale
Decreased blood pressure (hypotension) is a critical finding because it is a direct manifestation of anaphylactic shock, which involves massive systemic vasodilation and increased capillary permeability due to the widespread release of inflammatory mediators like histamine. Hypotension compromises tissue perfusion and can quickly lead to irreversible end-organ damage and death, making it the highest monitoring priority.
Choice B rationale
Lightheadedness is a subjective symptom often resulting from mild cerebral hypoperfusion secondary to systemic vasodilation or mild hypotension. While important, it is a downstream effect and less objectively indicative of the life-threatening severity of anaphylaxis than a measured, significant drop in systemic blood pressure.
Choice C rationale
Stomach pain (abdominal cramping) is a manifestation of gastrointestinal smooth muscle spasm and mucosal edema, common in systemic allergic reactions due to mediator release. Although distressing, it is not a direct threat to the client's airway or circulation, which are the immediate priorities in anaphylaxis management.
Choice D rationale
Urticaria (hives) results from the localized release of histamine causing dermal capillary dilation and leakage, leading to intensely pruritic, raised welts. This cutaneous finding, while a cardinal sign of an allergic reaction, does not indicate imminent hemodynamic collapse or airway obstruction like wheezing and hypotension do.
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