A nurse is caring for a client who was diagnosed with scleroderma 5 days ago. The nurse plans to assess the client to document the disease's progression.
In addition to skin changes, which of the following findings should the nurse expect?
Thinning of the skin.
Excessive salivation.
Periorbital edema.
Decreased range of motion.
The Correct Answer is D
Choice A rationale
Scleroderma typically causes a thickening and hardening of the skin, known as sclerodactyly, rather than thinning. The pathophysiology involves the excessive deposition of collagen in the dermis and subcutaneous tissues. This overproduction leads to skin that feels tight, bound down, and loses its natural elasticity. Thinning of the skin is more commonly associated with chronic corticosteroid use or natural aging rather than the fibrotic process that defines the progression of systemic or localized scleroderma.
Choice B rationale
Clients with scleroderma often suffer from xerostomia, which is extreme dryness of the mouth, rather than excessive salivation. This occurs because the fibrotic process can affect the salivary glands, reducing their ability to produce adequate moisture. Furthermore, many scleroderma patients also have secondary Sjogren syndrome, which further decreases glandular secretions. Excessive salivation would be an unusual finding and is not a clinical marker for the progression of the connective tissue fibrosis seen in this disease.
Choice C rationale
While some facial changes occur in scleroderma, such as a mask like appearance or restricted mouth opening, periorbital edema is not a standard expectation. Periorbital edema is more frequently associated with renal failure, nephrotic syndrome, or inflammatory conditions like dermatomyositis. In scleroderma, the skin around the eyes is more likely to become tight and taut due to collagen accumulation. The fibrotic nature of the disease usually results in tissue contraction and firmness rather than fluid accumulation.
Choice D rationale
Decreased range of motion is a common finding in scleroderma due to the hardening of the skin and fibrosis of the underlying connective tissues and tendons. As the skin becomes increasingly tight and rigid, it restricts the movement of the joints beneath it. This contracture development significantly impacts the functional mobility of the hands and limbs. Assessing for joint flexibility is essential to document disease progression as the fibrosis moves from the skin into deeper musculoskeletal structures.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
A bulging, red tympanic membrane is a classic diagnostic sign of acute otitis media, which is an infection of the middle eye space. Meniere's disease is a disorder of the inner ear involving endolymphatic hydrops, or fluid imbalance. In Meniere's disease, the physical examination of the external ear canal and the tympanic membrane usually reveals normal structures without signs of inflammation, redness, bulging, or infection-related pressure changes.
Choice B rationale
Purulent drainage, or otorrhea, is typically associated with otitis externa or a perforated tympanic membrane resulting from a middle ear infection. Meniere's disease does not involve infectious processes or the production of pus. It is characterized by a triad of symptoms including vertigo, tinnitus, and fluctuating sensorineural hearing loss. There is no physical pathway for internal fluid buildup in Meniere's disease to produce external drainage unless a secondary injury occurs.
Choice C rationale
Ototoxicity refers to the property of being toxic to the ear, specifically the cochlea or auditory nerve. While Meniere's disease itself is a primary inner ear pathology, patients often experience progressive sensorineural hearing loss that mimics ototoxic damage. Furthermore, some treatments for severe Meniere's, such as gentamicin injections, are intentionally ototoxic to ablate vestibular function. The expected finding in this disease process is the dysfunction of the vestibulocochlear system, leading to permanent hearing deficits.
Choice D rationale
Otalgia, or ear pain, is not a standard clinical manifestation of Meniere's disease. Patients with Meniere's usually report a sensation of fullness or pressure in the ear, known as aural fullness, rather than sharp or aching pain. Otalgia is more commonly linked to inflammatory conditions like mastoiditis, dental issues, or infections. The discomfort in Meniere's is related to the excessive accumulation of endolymph fluid within the labyrinth, causing equilibrium and hearing disturbances.
Correct Answer is A
Explanation
Choice A rationale
Cataracts involve the clouding of the crystalline lens of the eye, which normally focuses light onto the retina. As the lens becomes opaque due to protein clumping, light is scattered rather than focused, resulting in blurry or hazy vision. This progressive condition affects visual acuity and makes objects appear as if the person is looking through a frosted or fogged-up window, which is a classic clinical manifestation of cataract development.
Choice B rationale
The presence of dark spots moving across the visual field is usually indicative of vitreous floaters or potentially a retinal detachment. These spots are caused by shadows cast on the retina by microscopic fibers within the vitreous humor. While common with aging, they are not a primary symptom of cataracts, which focus on the clarity of the lens itself rather than the integrity of the vitreous or the posterior segment of the eye.
Choice C rationale
The inability to see objects from the side of the eyes refers to a loss of peripheral vision, which is a hallmark sign of glaucoma. In glaucoma, increased intraocular pressure damages the optic nerve, typically starting with the outer fibers that provide side vision. Cataracts generally cause a global decrease in clarity across the entire visual field rather than a specific loss of peripheral sight while maintaining central vision as seen in glaucoma.
Choice D rationale
Losing the ability to see things in the middle part of the eyes is characteristic of macular degeneration. The macula is responsible for sharp, central vision required for activities like reading or driving. Damage to this area causes a central blind spot or blurriness. Cataracts, conversely, create a generalized haze. While a cataract can be central, the specific complaint of losing central vision specifically points more toward retinal or macular pathology.
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