Autoimmune Disease

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Sample questions from Autoimmune Disease

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.In the emergency department, a 36-year-old client with systemic lupus erythematosus (SLE) reports new shortness of breath and sharp chest pain. The client is taking prednisone and mycophenolate. Temperature is 38.2 C, HR 124/min, RR 30/min, BP 88/54 mm Hg, and SpO2 89% on room air. Which action should the nurse take first?

   • A.Contact the client's rheumatology clinic to schedule an appointment
   • B.Provide written information about preventing infection while taking immunosuppressants
   • C.Arrange an urgent transfer to a higher level of care and notify the rapid response team
   • D.Ask the client to describe the usual pattern of SLE-related joint pain

   Rationale: Hypotension, tachycardia, fever, hypoxemia, and respiratory distress indicate possible life-threatening infection or cardiopulmonary compromise in an immunosuppressed client, requiring immediate escalation. Assessing joint pain and providing teaching can wait until the client is stabilized. A routine rheumatology appointment does not address the acute deterioration. The priority is to recognize instability and activate emergency care.

2. 2.At change of shift on a pediatric medical unit, a 13-year-old client with juvenile idiopathic arthritis is receiving methotrexate and has painful, swollen knees. The client is afebrile, and the next methotrexate dose is due today. Which actions should the nurse take as part of safe care coordination? Select all that apply.

   • A.Coordinate physical therapy around pain control and the client's activity tolerance
   • B.Tell the caregiver to stop methotrexate whenever the joint pain improves
   • C.Review required laboratory monitoring and report overdue or abnormal results to the prescriber
   • D.Arrange for the client to receive a live attenuated vaccine today without consulting the prescriber
   • E.Ask the client and caregiver whether the client could be pregnant before administering methotrexate
   • F.Verify the methotrexate dose, route, and weekly schedule against the medication record

   Rationale: Methotrexate is generally administered on a weekly schedule, so the nurse verifies the dose and timing to prevent potentially serious daily-dose errors. Because methotrexate can harm a fetus, pregnancy screening is appropriate for an adolescent before administration. Coordinating therapy with pain control supports function, while monitoring and reporting laboratory results helps identify toxicity. Live vaccines require prescriber review in an immunosuppressed client, and the caregiver should not independently stop treatment when symptoms improve.

3. 3.During a home visit, the parent of a 4-year-old child newly diagnosed with type 1 diabetes asks how to coordinate the child's care at preschool. The child uses insulin, and the parent reports that the preschool has no written emergency plan. Which action is most appropriate for the nurse?

   • A.Advise the parent to keep the child home until the child can independently administer insulin
   • B.Help the parent coordinate a written diabetes medical management plan with the prescriber and preschool staff
   • C.Recommend that preschool staff adjust insulin doses based on the child's appetite
   • D.Tell the parent to provide the preschool with insulin but not glucose-monitoring supplies

   Rationale: A coordinated written plan should specify glucose monitoring, insulin administration, meals, hypoglycemia treatment, and whom to contact in an emergency. A 4-year-old should not be expected to independently manage insulin, and excluding the child from preschool is unnecessary. Insulin adjustments must follow a prescriber's plan rather than staff improvisation, and glucose-monitoring and emergency supplies are essential.

4. 4.A 28-year-old client at 32 weeks of pregnancy has SLE and reports a new severe headache and blurred vision during a prenatal clinic visit. BP is 168/110 mm Hg, and urine dipstick shows 3+ protein. Which action should the nurse take?

   • A.Schedule a routine rheumatology visit to review the client's lupus medications
   • B.Ask the client to increase oral fluids and return for a urine test next week
   • C.Advise the client to rest at home and recheck the blood pressure tomorrow
   • D.Arrange immediate obstetric evaluation for a possible hypertensive pregnancy emergency

   Answer and rationale are in the full material.

5. 5.In a community clinic, a 17-year-old client with Crohn disease and a history of missed biologic therapy appointments says, "I do not want my parents to hear everything I discuss with the care team." Which response by the nurse best supports care coordination?

   • A.Explain the limits of confidentiality, then offer to discuss the client's concerns privately and involve the client in planning follow-up
   • B.Tell the client that parents must make all treatment decisions until age 18
   • C.Arrange the next biologic infusion without discussing the missed appointments
   • D.Promise that no information will ever be shared with the parents or health care team

   Answer and rationale are in the full material.