The client has been ordered allopurinol (Zyloprim) and is preparing for discharge. What should the nurse include in the discharge instructions?

Choice A reason: Lithium toxicity is a concern but not inevitable. It occurs with levels above 1.5 mEq/L, often due to dehydration or drug interactions, common in trauma settings. However, routine monitoring of levels is a more immediate nursing priority than assuming toxicity, as early detection prevents severe outcomes like seizures or renal damage.

Choice B reason: Lithium is primarily excreted by the kidneys, not metabolized by the liver. Liver function tests are not indicated for lithium monitoring, as it does not undergo hepatic metabolism. This statement is inaccurate, as renal function tests are critical to assess lithium clearance and prevent toxicity in trauma patients.

Choice C reason: Stress does not directly increase lithium requirements. Trauma-related dehydration or renal impairment can elevate lithium levels, risking toxicity, but this is due to reduced clearance, not increased need. This statement is inaccurate, as dosing adjustments should be based on serum levels, not stress alone.

Choice D reason: Lithium has a narrow therapeutic range (0.6-1.2 mEq/L), and trauma-related factors like dehydration or medications can alter levels, risking toxicity or subtherapeutic effects. Regular serum level monitoring is critical, especially in acute settings, to ensure safety and efficacy, making this statement accurate and a priority nursing concern.

Choice A reason: Systemic lupus erythematosus (SLE) is an autoimmune disease where the immune system produces autoantibodies, such as anti-nuclear antibodies, that attack healthy tissues like joints, skin, kidneys, and other organs. This leads to chronic inflammation and tissue damage. B-cell hyperactivity and T-cell dysfunction drive this process, causing systemic effects. This statement is accurate, as autoimmunity defines SLE’s pathology, distinguishing it from non-autoimmune disorders.

Choice B reason: Most individuals with SLE survive due to improved treatments like immunosuppressive drugs, with over 90% surviving beyond 10 years. However, it can be fatal due to complications such as kidney failure, cardiovascular disease, or infections during severe flares. This statement is accurate, reflecting the disease’s manageable yet potentially lethal nature, especially with organ involvement.

Choice C reason: Family history is a known risk factor for SLE. Genetic predisposition, particularly HLA gene variants, increases susceptibility. First-degree relatives of SLE patients have a 5-10% higher risk of developing the disease compared to the general population. This statement is inaccurate, as genetics significantly influences SLE onset, making it a key risk factor.

Choice D reason: SLE is a chronic, progressive connective tissue disorder characterized by periods of flares and remission. It affects connective tissues like joints and skin, with progressive organ damage possible in severe cases. This statement is accurate, as SLE’s chronic nature and connective tissue involvement are central to its pathophysiology, often requiring long-term management.