A nurse is caring for a client who is receiving phototherapy for psoriasis. Which of the following findings should the nurse identify as an indication of overexposure?

Increased joint pain

Increased body temperature

Cool, moist extremities

Small blisters on the skin

Answer and Explanation

The Correct Answer is D

A. Increased joint pain: Joint pain is not a typical sign of overexposure to phototherapy. While psoriatic arthritis can occur in individuals with psoriasis, it is not directly linked to phototherapy overexposure.

B. Increased body temperature: While phototherapy may slightly raise the body's temperature, a significant increase in body temperature is not a typical indication of overexposure. This could suggest another underlying issue, such as infection or heatstroke.

C. Cool, moist extremities: Cool, moist extremities are not typically associated with phototherapy overexposure. This finding is more indicative of circulatory or other systemic issues, which do not directly result from phototherapy.

D. Small blisters on the skin: Small blisters on the skin are a common sign of overexposure to phototherapy. Phototherapy uses ultraviolet (UV) light, and excessive exposure can lead to skin damage, including burns or blisters, similar to sunburn.

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Correct Answer is C

Explanation

A. Temperature 38.7° C (101.7° F): A temperature of 38.7° C (101.7° F) is elevated and may indicate an infection or inflammation, which is not expected after an EGD. A mild fever could occur briefly, but temperatures above 100.4° F should be monitored closely.

B. Heart rate 110/min: A heart rate of 110/min is elevated and may suggest tachycardia due to pain, anxiety, or potential complications. An elevated heart rate should be assessed further, as it is not typical during the recovery phase of an EGD procedure.

C. Respiratory rate 14/min: A respiratory rate of 14/min is within the normal range for an adult (12-20/min), indicating that the client is breathing comfortably and is recovering well from the procedure. This is an expected finding post-procedure.

D. SpO2 92%: An SpO2 level of 92% is slightly low. The normal range for oxygen saturation is typically 95-100%, and a reading of 92% may indicate mild hypoxemia, which should be further evaluated, especially if the client is recovering from sedation.

A. Increased urine output B. Petechiae C. Decreased respirations D. Bradycardia

Correct Answer is B

Explanation

A. Increased urine output: In disseminated intravascular coagulation (DIC), there is typically decreased urine output due to renal failure or microvascular clotting, not increased output.

B. Petechiae: Petechiae are small red or purple spots on the skin caused by bleeding under the skin. This is a common finding in DIC due to widespread clotting and subsequent bleeding, resulting in tiny hemorrhages.

C. Decreased respirations: Respiratory rate may actually increase in DIC due to hypoxia, sepsis, or pulmonary embolism rather than decrease. Respiratory complications are common in DIC.

D. Bradycardia: Bradycardia (slow heart rate) is not a typical finding in DIC. Instead, tachycardia (increased heart rate) is often observed as a compensatory response to hypovolemia or shock associated with DIC.

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A nurse is caring for a client who is receiving phototherapy for psoriasis. Which of the following findings should the nurse identify as an indication of overexposure?

Nursing Test Bank

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