Lupus Clinical Scenario Multiple Choice Questions

A 35-year-old woman presents with sudden worsening fatigue, arthralgias, periorbital edema, and a rising creatinine over 48 h—her most likely urgent complication is:

• Idiopathic thrombocytopenic purpura

• Membranous glomerulopathy

• Lupus nephritis class III/IV

• Minimal change disease

A lupus patient admitted for flare complains of pleuritic chest pain and dyspnea, and ECG shows diffuse ST elevations—this presentation most supports:

• Pulmonary embolism

• Acute MI

• Serositis/pericarditis

• Aortic dissection

A patient in remission of SLE plans pregnancy and is found positive for anti-Ro/SSA and anti-La/SSB antibodies; she should be counseled about:

• High risk of nephritis recurrence

• Neonatal lupus with congenital heart block

• Placental abruption

• Gestational diabetes

A SLE patient on cyclophosphamide develops dysuria and hematuria; the nurse’s priority teaching is:

• Increase calcium intake

• Force oral fluids and void after drug

• Avoid all protein

• Defer bladder ultrasound

An African American woman with lupus flare shows complement C3, C4 consumption, and rising anti-dsDNA titers; this pattern most strongly predicts:

• Cutaneous flare

• Renal involvement

• Hematologic relapse

• Neuropsychiatric flare

A lupus patient with known antiphospholipid syndrome develops sudden unilateral leg swelling and pain while hospitalized; the best immediate nursing action is:

A patient with lupus is to undergo major surgery and has been on chronic prednisone 20 mg daily; the perioperative steroid strategy should include:

• Discontinue and restart after surgery

• Continue usual dose only

• Administer “stress dose” steroids perioperatively

• Switch to hydrocortisone only

A 40-year-old lupus patient complains of sudden blurred vision in one eye and floaters; considering vasculitis risks, the nurse should suspect:

• Retinal vasculitis

• Cataract formation

• Glaucoma

• Migraine aura

A patient with SLE complains of new onset proximal muscle weakness and elevated CK; the nurse considers which drug is most likely contributory:

• Hydroxychloroquine

• Azathioprine

• High-dose corticosteroids

• ACE inhibitor

A lupus patient presents with sudden onset confusion, seizures, and focal neurologic deficits with normal CT scan; the nurse suspects:

• Stroke (ischemic)

• Neuropsychiatric lupus

• Intracranial hemorrhage

• Hypoglycemia