When educating a newly diagnosed client with systemic lupus erythematosus (SLE), which recommendation should the nurse include?

Choice A rationale

While notifying the healthcare provider is necessary, it is not the most immediate priority when the patient shows signs of hemodynamic instability. The nurse must first intervene to stabilize the patient's circulatory volume. Postoperative patients who have had surgery for Cushing's disease are at high risk for acute adrenal insufficiency. This occurs because the remaining adrenal tissue may be atrophied and unable to produce sufficient cortisol, leading to a life-threatening addisonian crisis.

Choice B rationale

Increasing oxygen flow may be supportive, but it does not address the underlying physiological cause of low blood pressure and tachycardia in this specific postoperative context. The primary issue is likely a lack of circulating cortisol and subsequent fluid volume deficit or vasodilation. While maintaining oxygen saturation is part of standard PACU care, it will not correct the hypotension or the potential adrenal crisis that is developing, making it a secondary intervention in this scenario.

Choice C rationale

Encouraging deep breaths is a standard intervention to prevent atelectasis and improve respiratory function after general anesthesia. However, it is not a priority when the patient is exhibiting signs of shock, such as hypotension and tachycardia. These vital sign changes suggest a cardiovascular or endocrine emergency rather than a primary respiratory problem. The nurse must focus on interventions that will restore blood pressure and ensure adequate organ perfusion to prevent further deterioration.

Choice D rationale

Administering IV fluids is the priority action to treat hypotension and tachycardia, which are signs of potential acute adrenal insufficiency or hypovolemia. In the absence of high cortisol levels after removing a tumor, the body cannot maintain vascular tone or fluid balance effectively. Rapid fluid resuscitation helps restore circulating volume and blood pressure. Following fluid initiation, the nurse should also prepare to administer parenteral hydrocortisone as ordered to replace the missing adrenal hormones.

Choice A rationale

Systemic lupus erythematosus is an autoimmune disease that can lead to complications such as preeclampsia, fetal growth restriction, and preterm birth. A collaborative care approach involving rheumatologists and obstetricians is essential for monitoring flares and fetal well-being. Close surveillance of renal function and blood pressure helps mitigate risks. Managing the disease effectively before and during pregnancy significantly improves outcomes for both the mother and the infant, making this the most important information to emphasize.

Choice B rationale

It is incorrect to suggest that patients should avoid all medications except those typically safe for the general population. Many SLE patients require specific immunosuppressants or corticosteroids to maintain remission, which is crucial for a successful pregnancy. While certain drugs like cyclophosphamide are contraindicated, others like hydroxychloroquine are often continued because the risk of a disease flare outweighs the potential risks to the fetus. Management is individualized rather than a blanket avoidance of medications.

Choice C rationale

Focusing only on physical symptoms while ignoring emotional well-being is an inappropriate management strategy. Chronic illnesses like SLE have significant psychological impacts, especially during the high-stress period of pregnancy. Emotional stress can potentially trigger disease flares through neuroendocrine pathways. Holistic care that includes mental health support and stress management is vital for the overall health of the pregnant patient and can improve adherence to complex medical regimens and improve maternal outcomes.

Choice D rationale

Claiming that SLE has no impact on pregnancy success is factually incorrect and misleading. SLE is a high-risk condition that requires intensive management to ensure a positive outcome. Even well-managed patients have a higher baseline risk for complications compared to the general population. While many women with SLE have successful pregnancies, the potential for lupus nephritis or placental insufficiency is always present. Providing accurate information about these risks is necessary for informed consent and proactive care. .