The nurse is caring for a school age child whose parent reports concern for the child's weight gain and obesity status. Which historical finding should the nurse recognize as potentially contributing to early obesity?

A. Body mass index greater than 35 kg/m². A BMI of ≥35 kg/m² indicates severe obesity and significantly increases the risk of chronic diseases such as hypertension, diabetes, and cardiovascular disease. Clients with a BMI ≥35, especially with comorbidities, should be referred for obesity counseling, lifestyle modifications, and possibly medical or surgical interventions.
B. Daily caloric intake of 3,500 calories. While consuming 3,500 calories daily may contribute to weight gain, caloric intake alone is not the primary indicator for an obesity counseling referral. BMI provides a more standardized measure of obesity risk.
C. Client's expressed desire to lose 50 lb (22.7 kg). A client’s motivation is important, but referral criteria for obesity counseling are based on clinical indicators like BMI rather than weight loss goals alone.
D. Body weight 10% over ideal body weight. Being 10% over ideal body weight does not necessarily indicate obesity. Obesity is typically defined as a BMI ≥30 kg/m², so this alone would not automatically warrant an obesity counseling referral.

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.