The nurse provides home care instructions to a client with systemic lupus erythematosus and tells the client about methods to manage fatigue. Which statement by the client indicates a need for further instruction?

Correct Answer: A

Rationale: Correct Answer: A Rationale: A: Taking hot baths can worsen fatigue in clients with lupus due to the potential of increasing body temperature and causing exhaustion. B: Sitting to conserve energy is a valid strategy to manage fatigue by minimizing physical exertion. C: Avoiding long periods of rest helps prevent joint stiffness and maintains mobility. D: Doing light exercises like walking can improve overall energy levels and physical condition. Summary: Choice A is incorrect as hot baths can exacerbate fatigue. Choices B, C, and D provide appropriate strategies for managing fatigue in clients with lupus.

Correct Answer: A

Rationale: The correct answer is A: Gait. Stavudine has been associated with peripheral neuropathy, which can lead to gait disturbances. Monitoring the client's gait closely is crucial to detect any signs of peripheral neuropathy early on. Other choices (B) Appetite, (C) Level of consciousness, and (D) Gastrointestinal function are not directly associated with stavudine use. Peripheral neuropathy is a known side effect of stavudine, making monitoring gait the priority in this scenario.

Correct Answer: C

Rationale: The correct approach is a bone marrow biopsy. The patient presents with pancytopenia (low Hb, WBC, platelets) which suggests a bone marrow issue. Bone marrow biopsy can reveal the cause of pancytopenia such as aplastic anemia, myelodysplastic syndrome, or leukemia. Erythropoietin level (A) is not indicated as low levels are expected in anemia. Serum B12 (B) is used for diagnosing B12 deficiency anemia, not pancytopenia. Liver spleen scan (D) is not helpful in this scenario. Bone marrow biopsy is the most direct and appropriate diagnostic test in this case.

Correct Answer: C

Rationale: The correct answer is C: Keep in hospital, discontinue heparin, start lepirudin. In this scenario, the patient has heparin-induced thrombocytopenia (HIT) with a platelet drop and is at risk for thrombosis. Lepirudin, a direct thrombin inhibitor, is the preferred anticoagulant in HIT. Dismissing on heparin and warfarin (choice A) is not appropriate due to HIT. Discontinuing heparin and adding aspirin (choice B) is not sufficient in managing HIT. Adding low-molecular-weight heparin (choice D) may worsen the thrombocytopenia.

Correct Answer: B

Rationale: The correct answer is B: Treat underlying disease. In this scenario, the patient is presenting with signs of disseminated intravascular coagulation (DIC) due to gram-negative sepsis. The priority is to address the underlying cause, which is the sepsis, to help improve the patient's condition. Treating the sepsis will help reduce the systemic inflammatory response and subsequent coagulopathy. The other options are not appropriate in this context: A (Begin heparin) can worsen bleeding in a patient with DIC, C (Begin plasmapheresis) is not indicated for DIC in sepsis, and D (Give vitamin K) does not address the main issue of sepsis-induced DIC.