- It reduces the immune-mediated damage to the self-tissues by inhibiting the synthesis of inflammatory mediators and suppressing the activation and proliferation of immune cells . Systemic lupus erythematosus is an autoimmune disease that affects multiple organ systems. It is characterized by autoantibody production that targets the self-tissues and causes inflammation and tissue damage. Prednisone is a glucocorticoid that works by inhibiting the synthesis of cytokines, chemokines, and other inflammatory mediators that mediate the immune response. Prednisone also suppresses the activation and proliferation of T cells, B cells, macrophages, and other immune cells that are involved in the pathogenesis of systemic lupus erythematosus .

- It reduces the inflammation and allergic reactions by inhibiting the synthesis of prostaglandins and leukotrienes . Prostaglandins and leukotrienes are lipid-derived inflammatory mediators that are involved in pain, fever, vasodilation, edema, and bronchoconstriction. Prednisone inhibits the enzyme cyclooxygenase (COX), which is responsible for converting arachidonic acid into prostaglandins. Prednisone also inhibits the enzyme 5-lipoxygenase, which is responsible for converting arachidonic acid into leukotrienes. By inhibiting these enzymes, prednisone reduces the production of prostaglandins and leukotrienes and their associated inflammatory and allergic effects .

The other options are incorrect because:

- A. It prevents or treats transplant rejection by suppressing the immune response to the foreign antigens on the donor organ is not an indication of prednisone in systemic lupus erythematosus. This is an indication of prednisone in organ transplantation, which is a different condition. Organ transplantation involves replacing a diseased or damaged organ with a healthy one from a donor. The immune system may recognize the donor organ as foreign and attack it, causing transplant rejection. Prednisone can prevent or treat transplant rejection by suppressing the immune response to the foreign antigens on the donor organ .

- D. It kills or inhibits the growth of malignant cells by interfering with the synthesis of nucleic acids is not an indication of prednisone in systemic lupus erythematosus. This is an indication of prednisone in cancer, which is a different condition. Cancer involves abnormal or uncontrolled growth of cells that invade and destroy normal tissues. Prednisone can kill or inhibit the growth of malignant cells by interfering with the synthesis of nucleic acids, which are essential for cell division and replication .

Known hypersensitivity to fludrocortisone or any component of the drug . Hypersensitivity is an exaggerated or inappropriate immune reaction to a substance that can cause allergic reactions such as rash, itching, hives, swelling, or difficulty breathing. The nurse should instruct the client to stop taking fludrocortisone and seek immediate medical attention if they experience any of these symptoms.

Pregnancy . Pregnancy is a condition in which a woman carries a developing fetus in her uterus. Fludrocortisone is a mineralocorticoid that can cross the placenta and affect the fetus. Fludrocortisone can cause fetal growth retardation, low birth weight, cleft palate, and adrenal insufficiency in the newborn. The nurse should instruct the client to use effective contraception while taking fludrocortisone and to inform their doctor if they become pregnant or plan to become pregnant.

Lactation . Lactation is the production and secretion of breast milk by a woman who has given birth. Fludrocortisone is a mineralocorticoid that can pass into breast milk and affect the nursing infant. Fludrocortisone can cause electrolyte imbalance, growth suppression, and adrenal suppression in the infant. The nurse should instruct the client not to breastfeed while taking fludrocortisone and to consult their doctor about alternative feeding methods.

The other options are incorrect because:

B. Diabetes mellitus, hypertension, heart failure, osteoporosis, glaucoma, cataracts, renal or hepatic impairment, bleeding disorders, and concurrent use of other immunosuppressive agents or live vaccines are not contraindications for fludrocortisone, but they are cautions or risk factors that may increase the likelihood of adverse effects or require dose adjustment or monitoring . These are conditions or factors that may affect the metabolism, excretion, efficacy, or safety of fludrocortisone. The nurse should assess the client's medical history and current medications before administering fludrocortisone and monitor their vital signs, blood glucose, electrolytes, bone density, intraocular pressure, liver function tests, coagulation tests, and immune status during treatment. The nurse should also educate the client about the potential adverse effects of fludrocortisone and how to prevent or manage them.

C. Hypertension, heart failure, renal or hepatic impairment, and concurrent use of other immunosuppressive agents or live vaccines are not specific contraindications for fludrocortisone, but they are cautions or risk factors that may increase the likelihood of adverse effects or require dose adjustment or monitoring . These are conditions or factors that may affect the metabolism, excretion, efficacy, or safety of fludrocortisone. The nurse should assess the client's medical history and current medications before administering fludrocortisone and monitor their vital signs, blood glucose, electrolytes, bone density, intraocular pressure, liver function tests, coagulation tests. The nurse should assess the client's medical history and current medications before administering fludrocortisone and monitor their vital signs, blood glucose, electrolytes, bone density, intraocular pressure, liver function tests, coagulation tests, and immune status during treatment. The nurse should also educate the client about the potential adverse effects of fludrocortisone and how to prevent or manage them.

D. Active infection, malignancy, pregnancy, lactation, peptic ulcer disease, and bleeding disorders are not specific contraindications for fludrocortisone, but they are contraindications for glucocorticoids in general . Glucocorticoids are a class of drugs that include fludrocortisone and prednisone. They have anti-inflammatory, immunosuppressive, and metabolic effects by binding to glucocorticoid receptors and modulating gene expression. Glucocorticoids can cause serious side effects such as infection, malignancy, teratogenicity, gastrointestinal bleeding and ulceration, and bleeding disorders by suppressing the immune system, increasing the risk of opportunistic infections and cancers, crossing the placenta and breast milk, inhibiting gastric mucosal protection and healing, and reducing platelet aggregation and clotting factors . The nurse should use glucocorticoids with caution in patients with these conditions or risk factors and monitor them closely for signs and symptoms of complications.

A. Infection due to suppression of the immune system and increased susceptibility to opportunistic pathogens such as fungi, viruses, bacteria, and parasites . Azathioprine is an antimetabolite that works by suppressing the immune system and reducing inflammation. It is used to treat Crohn's disease, a chronic inflammatory condition of the digestive tract that causes symptoms such as abdominal pain, diarrhea, weight loss, and fever. Azathioprine can reduce the ability of the immune system to fight off infections and increase the risk of serious or fatal infections. The nurse should instruct the client to monitor their temperature and white blood cell count regularly and report any signs of infection (such as fever, chills, sore throat, cough, or wound drainage) to their doctor. The nurse should also advise the client to avoid contact with people who have infections and to receive prophylactic antibiotics or antifungals as prescribed.

B. Gastrointestinal effects such as nausea, vomiting, diarrhea, ulceration, and bleeding due to irritation or erosion of the gastric mucosa, and hepatotoxicity due to metabolic stress on the liver . Azathioprine is an antimetabolite that works by interfering with the synthesis of nucleic acids, which are essential for cell division and replication. Azathioprine can affect the rapidly dividing cells of the gastrointestinal tract and cause gastrointestinal effects such as nausea, vomiting, diarrhea, ulceration, and bleeding. Azathioprine can also affect the liver and cause hepatotoxicity such as elevated liver enzymes, jaundice (yellowing of skin or eyes), hepatitis (inflammation of liver), or liver failure. The nurse should instruct the client to take azathioprine with food or milk to reduce stomach irritation and to drink plenty of fluids to prevent dehydration. The nurse should also instruct the client to monitor their liver function tests regularly and report any signs of liver injury (such as nausea, vomiting, anorexia (loss of appetite), fatigue, dark urine, or clay-colored stools) to their doctor.

C. Bone marrow suppression such as anemia (low red blood cell count), leukopenia (low white blood cell count), thrombocytopenia (low platelet count) due to interference with the synthesis of nucleic acids . Azathioprine is an antimetabolite that works by interfering with the synthesis of nucleic acids, which are essential for cell division and replication. Azathioprine can affect the rapidly dividing cells of the bone marrow and cause bone marrow suppression such as anemia, leukopenia, thrombocytopenia. These conditions can cause symptoms such as fatigue, weakness, pallor (pale skin), shortness of breath, increased susceptibility to infection, bruising, bleeding, or petechiae (small red spots on skin). The nurse should instruct the client to monitor their blood counts regularly and report any abnormal results or signs of bone marrow suppression to their doctor. The nurse should also advise the client to avoid activities that may cause injury or bleeding and to use caution when using sharp objects or dental floss.

D. Skin reactions such as rash, pruritus (itching), alopecia (hair loss), and photosensitivity (increased sensitivity to sunlight) due to hypersensitivity or allergic response to the drug . Azathioprine is an antimetabolite that can cause skin reactions such as rash, pruritus, alopecia. Azathioprine is an antimetabolite that can cause skin reactions such as rash, pruritus, alopecia, and photosensitivity due to hypersensitivity or allergic response to the drug . The nurse should instruct the client to stop taking azathioprine and seek immediate medical attention if they experience any severe or persistent skin reactions. The nurse should also inform the client that they may develop a delayed hypersensitivity reaction after several weeks or months of treatment that may manifest as fever, rash, joint pain, or lymph node enlargement. The nurse should instruct the client to report any of these symptoms to their doctor as well . The nurse should also advise the client to protect their skin from sun exposure by wearing sunscreen, hats, sunglasses, and clothing and to avoid tanning beds or lamps.

The nurse should monitor the client for signs and symptoms of these adverse effects and intervene as appropriate. The nurse should also educate the client about the importance of adhering to the prescribed dosage and schedule of azathioprine and not to stop or change the dose without consulting their doctor. The nurse should also remind the client to follow up with their doctor regularly and to have periodic blood tests to check their blood counts, liver function, and immune status.

Decreased frequency and severity of asthma attacks, wheezing, coughing, and dyspnea . These are the main symptoms of asthma, a chronic respiratory condition that causes inflammation and narrowing of the airways, resulting in difficulty breathing. Fluticasone is a corticosteroid that works by reducing inflammation and mucus production in the airways. Fluticasone can prevent or reduce the occurrence and intensity of asthma attacks and improve the airflow and lung function in patients with asthma .

The other options are incorrect because:

B. Increased appetite, weight gain, energy level, and quality of life are not outcomes that indicate the effectiveness of fluticasone therapy for asthma. These are outcomes that indicate the effectiveness of systemic corticosteroids such as prednisone or hydrocortisone, which are used to treat severe or life-threatening asthma exacerbations or other inflammatory conditions. Systemic corticosteroids have anti-inflammatory, immunosuppressive, and metabolic effects by binding to glucocorticoid receptors and modulating gene expression. Systemic corticosteroids can increase appetite, weight gain, energy level, and quality of life by reducing inflammation, pain, fatigue, and stress. However, systemic corticosteroids also have many adverse effects such as infection, osteoporosis, diabetes, hypertension, cataracts, glaucoma, mood changes, insomnia, acne. - Continue with the answer above. Systemic corticosteroids also have many adverse effects such as infection, osteoporosis, diabetes, hypertension, cataracts, glaucoma, mood changes, insomnia, acne, hirsutism, and adrenal suppression. Therefore, systemic corticosteroids should be used at the lowest effective dose and for the shortest possible duration to achieve the desired outcomes . Fluticasone is an inhaled corticosteroid that works locally in the lungs and has minimal systemic effects. Fluticasone does not have the same benefits or risks as systemic corticosteroids .

C. Normalized blood glucose, electrolytes, blood count, and liver function tests are not outcomes that indicate the effectiveness of fluticasone therapy for asthma. These are outcomes that indicate the prevention or reduction of adverse effects of systemic corticosteroids such as prednisone or hydrocortisone, which are used to treat severe or life-threatening asthma exacerbations or other inflammatory conditions. Systemic corticosteroids have anti-inflammatory, immunosuppressive, and metabolic effects by binding to glucocorticoid receptors and modulating gene expression. Systemic corticosteroids can affect blood glucose, electrolytes, blood count, and liver function tests by altering carbohydrate, protein, fat, water, and mineral metabolism. The nurse should monitor these parameters regularly and report any abnormal results or changes to the doctor. The nurse should also educate the client about the potential adverse effects of systemic corticosteroids and how to prevent or manage them. Fluticasone is an inhaled corticosteroid that works locally in the lungs and has minimal systemic effects. Fluticasone does not have the same effects or risks as systemic corticosteroids .

D. Reduced inflammation and mucus production in the airways is not an outcome that indicates the effectiveness of fluticasone therapy for asthma. This is a mechanism of action of fluticasone therapy for asthma. Fluticasone is a corticosteroid that works by reducing inflammation and mucus production in the airways. Fluticasone can prevent or reduce the occurrence and intensity of asthma attacks and improve the airflow and lung function in patients with asthma . However, this mechanism of action is not directly observable or measurable by the client or the nurse. The nurse should evaluate the outcomes that reflect the clinical improvement of asthma symptoms and signs such as decreased frequency and severity of asthma attacks, wheezing, coughing, and dyspnea; improved peak expiratory flow and forced expiratory volume in one second; and reduced need for rescue medication such as short-acting beta2 agonists.

A. It should be given intravenously slowly over 2 hours to prevent infusion reactions such as fever, chills, rash, pruritus, and dyspnea . Infliximab is a monoclonal antibody that works by blocking the action of tumor necrosis factor-alpha (TNF-alpha), a cytokine that mediates inflammation and tissue damage in ulcerative colitis. Infliximab can cause infusion reactions such as fever, chills, rash, pruritus, and dyspnea during or shortly after the infusion. These reactions are usually mild to moderate and can be prevented or managed by slowing down the infusion rate, premedicating with antihistamines, acetaminophen, or corticosteroids, and monitoring the vital signs and symptoms of the client. The nurse should instruct the client to report any signs of infusion reaction to the health care provider immediately.

B. It should be given with concomitant immunosuppressive agents such as azathioprine or methotrexate to enhance its efficacy and reduce antibody formation . Infliximab is a monoclonal antibody that works by blocking the action of TNF-alpha, a cytokine that mediates inflammation and tissue damage in ulcerative colitis. Infliximab can lose its efficacy over time due to the formation of antibodies against it. These antibodies can also increase the risk of adverse effects such as infusion reactions, infection, or malignancy. To prevent or reduce antibody formation, infliximab should be given with concomitant immunosuppressive agents such as azathioprine or methotrexate. These agents can also enhance the efficacy of infliximab by suppressing the immune system and reducing inflammation. The nurse should instruct the client to take these agents as prescribed by their doctor and to monitor their blood counts and liver function tests regularly.

C. It should be given with prophylactic antibiotics or antifungals to prevent infection due to suppression of the immune system . Infliximab is a monoclonal antibody that works by blocking the action of TNF-alpha, a cytokine that mediates inflammation and tissue damage in ulcerative colitis. Infliximab can suppress the immune system and increase the risk of serious or fatal infections such as tuberculosis, fungal infections, bacterial infections, viral infections, or parasitic infections. To prevent or treat these infections, infliximab should be given with prophylactic antibiotics or antifungals as prescribed by their doctor. The nurse should instruct the client to undergo screening tests for latent tuberculosis and hepatitis B before starting infliximab therapy and to report any signs of infection (such as fever, chills, sore throat, cough, or wound drainage) to their doctor. The nurse should also advise the client to avoid contact with people who have infections and to receive inactivated vaccines as recommended by their doctor.

D. It should be monitored for signs of hypersensitivity, infection, malignancy, and hepatotoxicity during and after the infusion . Infliximab is a monoclonal antibody that works by blocking the action of TNF-alpha, a cytokine that mediates inflammation and tissue damage in ulcerative colitis. Infliximab can cause serious adverse effects such as hypersensitivity reactions (such as anaphylaxis or serum sickness), infection (such as tuberculosis or fungal infections), malignancy (such as lymphoma or skin cancer), and hepatotoxicity (such as elevated liver enzymes or liver failure). The nurse should monitor the client for signs and symptoms of these adverse effects during and after the infusion and intervene as appropriate. The nurse should also educate the client about the potential adverse effects of infliximab and how to prevent or manage them.