A nurse is caring for a patient who is experiencing respiratory distress.
Which of the following early manifestations of hypoxemia should the nurse recognize?

Choice A rationale

Psoriasis is a chronic, autoimmune skin disorder characterized by the rapid overproduction of skin cells, leading to the formation of thick, red plaques covered with silvery-white scales. These lesions are a result of keratinocyte proliferation and inflammation. The most common sites for these plaques are the extensor surfaces of the body, such as the scalp, knees, and elbows, due to repetitive trauma or friction (Koebner phenomenon).

Choice B rationale

Red-purplish scaly lesions are more characteristic of other inflammatory skin conditions, such as lichen planus, not psoriasis. Psoriasis typically presents with a well-demarcated, erythematous base covered by silvery-white scales. The color and scale characteristics are key differentiators in the clinical diagnosis of skin disorders.

Choice C rationale

Psoriasis is typically associated with dry, not oily, skin. The rapid cell turnover and scale formation lead to significant epidermal dryness. Furthermore, pruritus (itching) is a common symptom of psoriasis, often a major source of discomfort for patients. The absence of pruritus is not a characteristic of this condition.

Choice D rationale

Nail changes are a very common manifestation of psoriasis, affecting up to 50% of patients. These changes include pitting, discoloration, onycholysis (separation of the nail from the nail bed), and thickening. Clear, thin nail beds are a sign of healthy nails, not a characteristic finding in a patient with psoriasis.

Choice A rationale

A loud, brassy cough in a burn patient rescued from a fire is a critical sign of upper airway edema, often caused by inhalation of hot gases or toxins. This swelling can rapidly lead to complete airway obstruction. Antitussive medications suppress coughing and would mask this vital clinical sign, delaying the necessary and immediate intervention of securing the airway.

Choice B rationale

Providing ice chips or sips of water may be considered for a sore throat, but in the context of a potential inhalation injury, this action is contraindicated. Swelling of the laryngeal and pharyngeal tissues can progress rapidly, and there is a high risk of aspiration if the patient's swallowing reflex is compromised or the airway becomes obstructed.

Choice C rationale

Humidified air can help soothe irritated mucous membranes, but it is not the first action in a patient with a rapidly deteriorating airway. The loud, brassy cough signifies significant laryngeal edema, which can progress to complete obstruction. The immediate priority is to assess, stabilize, and protect the airway with supplemental oxygen and continuous monitoring before it closes.

Choice D rationale

A loud, brassy cough is a hallmark sign of upper airway edema, a serious complication of inhalation injury. The swelling can quickly lead to airway obstruction. Applying oxygen and continuous pulse oximetry is the first action to ensure adequate oxygenation and monitor for signs of impending respiratory failure, while simultaneously preparing for definitive airway management.