The nurse is assessing the nutritional status of a group of clients in a long term care facility. Which pathophysiological process poses the highest risk for malnutrition in this population?

A. Brown, rough, greasy, wart-like papules on the face. These describe seborrheic keratosis, a benign skin growth, which is unrelated to overexposure from PUVA therapy.
B. Requires sunglasses because sunlight hurts eyes. PUVA therapy increases sensitivity to light, and clients are advised to wear sunglasses. However, light sensitivity alone does not indicate overexposure. Severe overexposure could cause ocular damage or photokeratitis, but this symptom alone is not diagnostic of excessive treatment.
C. Tenderness upon palpation and generalized erythema. Overexposure to PUVA therapy can cause phototoxic reactions, including skin tenderness, erythema (similar to a sunburn), and blistering. These signs indicate that the client has received too much ultraviolet A (UVA) exposure, requiring treatment adjustments to prevent further skin damage.
D. Thick skin plaques topped by silvery white scales. These are classic symptoms of psoriasis vulgaris and do not indicate overexposure. In fact, PUVA therapy is used to reduce these plaques, not cause them.

A. Explain that the child is likely to grow into her weight. This is incorrect because a BMI at the 85th percentile indicates that the child is overweight. Without intervention, the risk of continued excess weight gain and future obesity increases.
B. Obtain the child's 3-day diet history based on the mother's input. Assessing the child's dietary habits helps identify potential areas for improvement, such as reducing sugary drinks or increasing fruit and vegetable intake. Understanding the child’s nutrition is essential for developing a healthy eating plan.
C. Tell the mother that girls hit their growth spurt before boys so eating more is expected. While girls do experience growth spurts earlier than boys, this does not justify excessive weight gain. Encouraging healthy eating and physical activity is more appropriate than assuming the child will "grow out of it."
D. Inquire as to whether or not the school has a physical education program. School-based physical activity plays an important role in weight management. If the school lacks a structured program, additional strategies for physical activity should be explored.
E. Determine the child's usual physical activity pattern. Assessing the child’s activity level helps identify if sedentary behaviors (e.g., excessive screen time) are contributing to weight gain. Encouraging regular physical activity is a key part of managing childhood obesity.