Which finding for a patient who is taking hydroxychloroquine (Plaquenil) to treat rheumatoid arthritis is likely to be an adverse effect of the medication?

a. Blurred vision

b. Joint tenderness

c. Abdominal cramping

d. Elevated blood pressure

D.W. is a 25-year-old married woman with three children under 5 years old. She came to her physician 7 months ago with vague complaints of intermittent fatigue, joint pain, low-grade fever, and unintentional weight loss. Her physician noted small, patchy areas of vitiligo and a scaly rash across her nose, cheeks, back, and chest at that time. Laboratory studies revealed that D.W. had a positive antinuclear antibody (ANA) titer, positive anti-dsDNA test, positive anti-Sm test, elevated (-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), and decreased C3 and C4 serum complement. Joint x-ray films demonstrated joint swelling without joint erosion. D.W. was diagnosed with systemic lupus erythematosus (SLE). Her initial treatment consisted of hydroxychloroquine (Plaquenil) 400 mg and prednisone (Deltasone) 20 mg orally per day, bed rest, and ice packs. D.W. responded well and the steroid was tapered and discontinued. She was told she could report for follow-up every 6 months unless her symptoms became acute. D.W. resumed her job in environmental services at a large geriatric facility.
Given that most tests are nonspecific, how is SLE diagnosed?

D.W. is a 25-year-old married woman with three children under 5 years old. She came to her physician 7 months ago with vague complaints of intermittent fatigue, joint pain, low-grade fever, and unintentional weight loss. Her physician noted small, patchy areas of vitiligo and a scaly rash across her nose, cheeks, back, and chest at that time. Laboratory studies revealed that D.W. had a positive antinuclear antibody (ANA) titer, positive anti-dsDNA test, positive anti-Sm test, elevated (-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), and decreased C3 and C4 serum complement. Joint x-ray films demonstrated joint swelling without joint erosion. D.W. was diagnosed with systemic lupus erythematosus (SLE). Her initial treatment consisted of hydroxychloroquine (Plaquenil) 400 mg and prednisone (Deltasone) 20 mg orally per day, bed rest, and ice packs. D.W. responded well and the steroid was tapered and discontinued. She was told she could report for follow-up every 6 months unless her symptoms became acute. D.W. resumed her job in environmental services at a large geriatric facility.
What priority problems would be addressed in D.W.'s care plan at that time of diagnosis?

D.W. is a 29-year-old married woman with three children under 5 years of age. She saw her provider 7 months ago with intermittent fatigue, joint pain, low-grade fever, and unintentional weight loss. Her provider noted small, patchy areas of vitiligo and a scaly rash across her nose, cheeks, back, and chest at that time. Lab studies showed D.W. had a positive antinuclear antibody (ANA) titer, positive anti-dsDNA test, positive anti-Sm test, elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), and decreased C3 and C4 serum complement. Joint $x$-ray films showed joint swelling without joint erosion. D.W. was diagnosed with systemic lupus erythematosus (SLE). Initial treatment consisted of hydroxychloroquine (Plaquenil), prednisone, and naproxen sodium, and ice packs. D.W. responded well and the steroid was tapered and stopped. She was told she could follow up every 6 months unless her symptoms became acute. D.W. resumed her job in medical billing at a large geriatric facility. What priority problems would be addressed in D.W.'s care plan at the time of diagnosis?

A nurse is collecting data from a client with rheumatoid arthritis who has been taking high doses of prescribed hydroxychloroquine. Which of the following client statements should indicate to the nurse that the client is experiencing an adverse effect of hydroxychloroquine?

A. "I have developed sores in my mouth."

B. "I often feel like the room is spinning."

C. "I noticed that the whites of my eyes look yellow."

D. "I have had a change in my vision recently."

D.W. is a 25-year-old married woman with three children under 5 years old. She came to her physician 7 months ago with vague complaints of intermittent fatigue, joint pain, low-grade fever, and unintentional weight loss. Her physician noted small, patchy areas of vitiligo and a scaly rash across her nose, cheeks, back, and chest at that time. Laboratory studies revealed that D.W. had a positive antinuclear antibody (ANA) titer, positive anti-dsDNA test, positive anti-Sm test, elevated (-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), and decreased C3 and C4 serum complement. Joint x-ray films demonstrated joint swelling without joint erosion. D.W. was diagnosed with systemic lupus erythematosus (SLE). Her initial treatment consisted of hydroxychloroquine (Plaquenil) 400 mg and prednisone (Deltasone) 20 mg orally per day, bed rest, and ice packs. D.W. responded well and the steroid was tapered and discontinued. She was told she could report for follow-up every 6 months unless her symptoms became acute. D.W. resumed her job in environmental services at a large geriatric facility.

What is the significance of each ofD.W.'s laboratory findings?

What is the risk associated with hydroxychloroquine?

A nurse is providing teaching to a client who has a new prescription for hydroxychloroquine to treat mild manifestations of rheumatoid arthritis. Which of the following information should the nurse include in the teaching?

A. This medication should be taken between meals.

B. This medication can turn skin an orange color.

C. Wear sunglasses when out in bright sunshine.

D. Avoid crushing the medication.

D.W. is a 29-year-old married woman with three children under 5 years of age. She saw her provider 7 months ago with intermittent fatigue, joint pain, low-grade fever, and unintentional weight loss. Her provider noted small, patchy areas of vitiligo and a scaly rash across her nose, cheeks, back, and chest at that time. Lab studies showed D.W. had a positive antinuclear antibody (ANA) titer, positive anti-dsDNA test, positive anti-Sm test, elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), and decreased C3 and C4 serum complement. Joint $x$-ray films showed joint swelling without joint erosion. D.W. was diagnosed with systemic lupus erythematosus (SLE). Initial treatment consisted of hydroxychloroquine (Plaquenil), prednisone, and naproxen sodium, and ice packs. D.W. responded well and the steroid was tapered and stopped. She was told she could follow up every 6 months unless her symptoms became acute. D.W. resumed her job in medical billing at a large geriatric facility. Using the mnemonic SOAP BRAIN MD, how is SLE diagnosed?

D.W. is a 29-year-old married woman with three children under 5 years of age. She saw her provider 7 months ago with intermittent fatigue, joint pain, low-grade fever, and unintentional weight loss. Her provider noted small, patchy areas of vitiligo and a scaly rash across her nose, cheeks, back, and chest at that time. Lab studies showed D.W. had a positive antinuclear antibody (ANA) titer, positive anti-dsDNA test, positive anti-Sm test, elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), and decreased C3 and C4 serum complement. Joint $x$-ray films showed joint swelling without joint erosion. D.W. was diagnosed with systemic lupus erythematosus (SLE). Initial treatment consisted of hydroxychloroquine (Plaquenil), prednisone, and naproxen sodium, and ice packs. D.W. responded well and the steroid was tapered and stopped. She was told she could follow up every 6 months unless her symptoms became acute. D.W. resumed her job in medical billing at a large geriatric facility. What is the significance of each of D.W.'s lab findings?

D.W. is a $25$-year-old married woman with three children under $5$ years old. She came to her physician $7$ months ago with vague complaints of intermittent fatigue, joint pain, low-grade fever, and unintentional weight loss.

Her physician noted small, patchy areas of vitiligo and a scaly rash across her nose, cheeks, back, and chest at that time. Laboratory studies revealed that D.W. had a positive antinuclear antibody (ANA) titer, positive dsDNA (positive lupus erythematosus), positive anti-Sm (anti-smooth muscle antibody), elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), and decreased C$_3$ and C$_4$ serum complement. Joint $x$-ray films demonstrated joint swelling without joint erosion. D.W. was subsequently diagnosed with systemic lupus erythematosus (SLE). She was initially treated with hydroxychloroquine (Plaquenil) $400 \mathrm{mg}$ and Deltasone (Prednisone) $20 \mathrm{mg}$ orally per day, bed rest, and ice packs. D.W. responded well to treatment, the steroid was tapered and discontinued, and she was told she could report for follow-up every 6 months unless her symptoms became acute. D.W. resumed her job in environmental services at a large geriatric facility.

D.W. is seen in the immunology clinic twice monthly during the next $3$months. Although her condition does not worsen, her BUN and creatinine remain elevated. While at work one afternoon, D.W. begins to feel dizzy and develops a severe headache. She reports to her supervisor, who has her lie down. When D.W. starts to become disoriented, her supervisor calls $911$, and D.W. is taken to the hospital. D.W. is admitted for probable lupus cerebritis related to acute exacerbation of her disease.

A nurse is assessing a client who has systemic lupus erythematosus and is taking hydroxychloroquine. The nurse should report which of the following adverse effects to the provider immediately?

A. Diarrhea

B. Blurred vision

C. Pruritus

D. Fatigue

A nurse is reviewing medication orders for a female patient with SLE who is positive for the presence of antiphospholipid antibodies. The nurse would seek clarification from the provider about which type of medication?

1. Oral contraceptives

2. Hydroxychloroquine (antimalarial)

3. Glucocorticoid medication

4. NSAID

The antimetabolite that blocks DNA synthesis by interfering with folic acid is

A. mercaptopurine

B. fluorouracil

C. methotrexate

D. cytarabine

E. tamoxifen