The nurse is caring for a client diagnosed with psoriasis vulgaris who is receiving psoralen and ultraviolet A light (PUVA) treatment. Which assessment finding indicates that the client has been overexposed to the treatment?
Tenderness upon palpation and generalized erythema.
Thick skin plaques topped by silvery white scales.
Requires sunglasses because sunlight hurts eyes.
Brown, rough, greasy, wart-like papules on the face.
The Correct Answer is A
A. Tenderness upon palpation and generalized erythema indicate skin irritation and possible sunburn, which are signs of overexposure to PUVA treatment. This finding suggests that the client may have received excessive ultraviolet exposure, leading to skin damage.
B. Thick skin plaques topped by silvery white scales are characteristic of psoriasis vulgaris itself, not a sign of overexposure to PUVA.
C. Requiring sunglasses because sunlight hurts the eyes may indicate sensitivity but is not a specific indicator of overexposure to PUVA treatment; it could relate to other issues such as underlying eye conditions.
D. Brown, rough, greasy, wart-like papules on the face are not typically associated with PUVA overexposure but could be related to other skin conditions or lesions.
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Correct Answer is C
Explanation
A. "Take the vital signs on all the patients in the lounge and tell me whether there are problems." This instruction is vague and lacks specific information about what "problems" to look for, which may lead to inconsistent reporting.
B. "Do the morning care first on the patients in 205 and 206 who can't get out of bed." This instruction is clear, but it does not specify important details like the specific type of care expected or additional needs.
C. "Give the patient in 204A a shower after breakfast, and call me to check her feet before you get her dressed." This instruction is specific, clear, and provides a follow-up action (check her feet) which is necessary. It allows the nursing assistant to understand exactly what to do and when.
D. "You take care of all the patients in 205 and 206. Let me know how you're doing and whether you need any help." This instruction lacks specificity and does not outline clear tasks or expectations, which may lead to confusion.
Correct Answer is D
Explanation
A. While obtaining a keyboard designed to limit wrist flexion may be beneficial for ergonomics, it does not specifically address the symptoms or management of Raynaud's syndrome.
B. Taking a multivitamin with vitamin D may not have a direct impact on Raynaud's syndrome and is generally unrelated to the specific concerns of this condition.
C. Keeping hands elevated during breaks does not effectively address the primary concern of temperature regulation that affects Raynaud's syndrome.
D. Using a space heater is a practical measure that can help keep the workspace warm, thereby reducing the likelihood of Raynaud's attacks, which are triggered by cold temperatures and stress.