Which statement by a client with systemic lupus erythematosus (SLE) indicates the best understanding of proper skin care?

"I should apply drying agents on my draining lesions every day."

"I need to make sure no one else comes in contact with my skin rash."

"Tanning booths are okay to use, but I need to stay out of direct sunlight."

"If I'm out in the sun, I need to use a very strong sunblock."

Answer and Explanation

The Correct Answer is D

Choice A reason: Applying drying agents on draining lesions every day is not recommended for clients with SLE. This approach can lead to excessive dryness and irritation of the skin, which can worsen the condition and cause additional discomfort. Moisturizing and protecting the skin are more appropriate measures.

Choice B reason: While avoiding contact with others can help prevent the spread of infections, it is not the most important aspect of skin care for SLE. SLE is an autoimmune condition, and managing skin care focuses more on protecting the skin from external triggers and minimizing inflammation.

Choice C reason: Tanning booths are not safe for clients with SLE. Exposure to UV light, whether from the sun or artificial sources, can exacerbate SLE symptoms and trigger flares. Therefore, it is important to avoid both direct sunlight and tanning booths.

Choice D reason: Using a very strong sunblock when out in the sun is crucial for clients with SLE. Sun exposure can worsen skin lesions and trigger flares, so it is essential to protect the skin with a high SPF sunblock, wear protective clothing, and seek shade whenever possible.

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Correct Answer is A

Explanation

Choice A reason: Starting pelvic floor exercises might be beneficial in the long term for improving urinary control after TURP. However, immediately following the surgery and while the indwelling catheter is in place, it may not be the appropriate time to begin these exercises. The nurse should clarify when and how to start pelvic floor exercises.

Choice B reason: Reporting fever or chills is crucial because these symptoms could indicate an infection, which requires prompt medical attention. This statement reflects an understanding of important post-operative care instructions and does not need clarification.

Choice C reason: Increasing fluid intake to help with hydration is important for clients with a urinary catheter. Adequate hydration helps flush the urinary system and prevent complications such as urinary tract infections. This statement does not need clarification.

Choice D reason: Taping the urinary catheter securely to the thigh helps prevent tension on the catheter and reduces the risk of accidental dislodgement or trauma. This instruction is correct and does not need clarification.

A. Notify the charge nurse that the client will need assignment to the COVID-19 specified area of the facility. B. Place the nasal swab specimen for COVID-19 directly into a biohazard bag. C. Maintain a 6 feet (1.8 meters) distance from the client unless wearing an N95 respirator and personal protective equipment (PPE) for droplet precautions. D. Start an intravenous infusion for an antiviral drug to be administered for positive COVID-19 test results.

Correct Answer is C

Explanation

Choice A reason: Notifying the charge nurse that the client will need assignment to the COVID-19 specified area of the facility is an important action for infection control. However, the most immediate priority is to protect oneself and others by maintaining appropriate distance and using PPE.

Choice B reason: Placing the nasal swab specimen for COVID-19 directly into a biohazard bag is necessary for safe specimen handling and to prevent contamination. While important, it follows after ensuring that proper PPE is used and distancing measures are maintained.

Choice C reason: Maintaining a 6 feet (1.8 meters) distance from the client unless wearing an N95 respirator and personal protective equipment (PPE) for droplet precautions is the most crucial action. This step ensures the nurse’s safety and reduces the risk of virus transmission. Proper PPE and distancing protocols are essential in managing a suspected COVID-19 case.

Choice D reason: Starting an intravenous infusion for an antiviral drug to be administered for positive COVID-19 test results is part of the treatment plan if the test comes back positive. However, this step comes after ensuring safety through proper use of PPE and maintaining distance from the client.

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Which statement by a client with systemic lupus erythematosus (SLE) indicates the best understanding of proper skin care?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is providing education to a client who is returning home with an indwelling urinary catheter after having a transurethral resection of the prostate (TURP). Which statement made by the client demonstrates a need for the nurse to clarify the instructions?

Correct Answer is A

Explanation

The nurse is preparing to obtain a rapid coronavirus (COVID-19) test for a client who was exposed to the virus eight days ago. The client is experiencing fever, cough, and shortness of breath. Which action is most important for the nurse to take?

Correct Answer is C

Explanation

The nurse is caring for a client admitted to the unit for possible hyperthyroidism. The client describes weakness, nervousness, a racing heartbeat, and recent weight loss of 15 pounds (6.8 kg). Which action should the nurse implement first?

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While assisting a client to the toilet, the client begins to have a seizure and the nurse eases the client to the floor. The nurse calls for help and monitors the client until the seizing stops. Which intervention should the nurse implement first?

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The nurse is caring for an older adult client with Alzheimer's disease who becomes increasingly agitated and is speaking to someone who is not visible to the nurse. Which action should the nurse implement?

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