What is an ominous sign of advanced SLE?

Choice A reason: Increasing dietary protein and carbohydrates is not specific to SLE management. While nutrition supports overall health, SLE requires focus on photosensitivity, inflammation control, and organ protection. Recommending this risks diverting attention from critical interventions like sun protection or immunosuppression, potentially worsening SLE symptoms like rashes or flares.

Choice B reason: Nonpharmacologic pain interventions are adjunctive but not a substitute for analgesics in SLE, where pain from arthritis or organ involvement often requires medications like NSAIDs or hydroxychloroquine. Prioritizing nonpharmacologic methods alone risks inadequate pain control, reducing quality of life and misaligning with evidence-based SLE management strategies.

Choice C reason: Avoiding sunlight is critical in SLE, as ultraviolet exposure triggers photosensitive rashes and systemic flares in 70% of patients. Sun protection (sunscreen, clothing, avoiding peak hours) reduces cutaneous and systemic inflammation, preventing exacerbations. This teaching is essential for disease control, improving outcomes and patient comfort in SLE management.

Choice D reason: Genetic counseling is not routinely required for SLE family planning, as it’s not primarily hereditary, though genetic factors contribute. Counseling may be relevant for specific concerns, but it’s less critical than sun avoidance. Prioritizing this misguides teaching, potentially causing unnecessary worry and overlooking key SLE management strategies.

Choice A reason: Choosing red meat over poultry is incorrect, as both are high in purines, which increase uric acid levels, triggering gout attacks. Red meat, like beef, is particularly purine-rich, worsening hyperuricemia. A low-purine diet emphasizes plant-based proteins and low-purine options like eggs or dairy, indicating the client misunderstands dietary restrictions for gout management.

Choice B reason: Stating only white wine is allowed is incorrect, as all alcohol, including white wine, increases uric acid production and reduces its excretion, exacerbating gout. Beer and liquor are particularly high-risk, but no alcohol is recommended. This statement reflects a misunderstanding of the low-purine diet, which advises complete alcohol avoidance to prevent flare-ups.

Choice C reason: Avoiding liver and organ meats is correct, as these are extremely high in purines, which metabolize into uric acid, promoting gout attacks. A low-purine diet excludes organ meats, shellfish, and certain fish to reduce uric acid levels. This statement demonstrates accurate understanding of dietary restrictions essential for managing gout and preventing recurrent episodes.

Choice D reason: Not limiting fruit servings is generally true, as most fruits are low in purines. However, this statement is less specific to gout management than avoiding organ meats, which directly addresses a primary purine source. Fruits like cherries may even reduce gout risk, but this choice is less indicative of comprehensive dietary understanding.