The nurse should assess a patient with psoriasis for?

NHM MP Staff Nurse - 2015

Medical & Surgical Nursing

Easy

Appeared in: NHM MP Staff Nurse - 2015

Explanation

The most specific and classic sign of plaque psoriasis is the presence of well-demarcated, erythematous (red) plaques.
These plaques are covered with characteristic shiny, silvery-white, adherent scales.
This unique appearance is caused by an autoimmune-driven hyperproliferation of keratinocytes, leading to a rapid buildup of immature skin cells.
Common locations for these lesions include extensor surfaces like the elbows and knees, the scalp, and the lower back.

Option A: Petechiae are tiny, non-blanching red spots resulting from minor bleeding under the skin. This is not a feature of the inflammatory process in psoriasis.
Option B: Macules are flat, discolored spots on the skin. The characteristic lesion of psoriasis is a plaque, which is, by definition, raised and palpable.
Option D: While psoriasis lesions are often pruritic (itchy), this is a non-specific symptom. Many dermatological conditions cause itching (e.g., eczema, urticaria, scabies). The morphological description of 'shiny, silvery scaly lesions' is far more specific to psoriasis.

Clinical Relevance

Nursing practice connection: Use the key finding related to Clinical Manifestations of Psoriasis to guide bedside assessment, documentation, and the next nursing action.
Nurses play a crucial role in educating patients about psoriasis management, including gentle skin care, use of emollients, and avoiding triggers like stress, skin trauma (Koebner phenomenon), and certain medications.
It is vital to assess the psychological impact of psoriasis, as the visible lesions can cause significant emotional distress, social anxiety, and depression.
What if? If a patient with psoriasis also complains of persistent joint pain, morning stiffness, and swollen fingers or toes, the nurse must suspect the development of psoriatic arthritis. This requires prompt referral to a rheumatologist, as early treatment can prevent irreversible joint damage.

How to Approach the Question

First, identify the core subject of the question, which is the assessment of a patient with 'psoriasis'.
Recall the classic, hallmark signs of this specific disease. For psoriasis, this is the well-known psoriatic plaque.
Systematically evaluate each option to determine which one provides the most accurate and specific description of this hallmark sign.
Option A (petechiae) and B (macules) describe different types of skin lesions entirely. Eliminate them.
Compare the remaining options. Option D (pruritic lesions) describes a symptom (itching), which is common but not specific. Option C (shiny, silvery scaly lesions) describes the unique appearance of the psoriatic plaque.
Select the option that is the most precise and pathognomonic description, which is the shiny, silvery scale on a raised plaque.

Concept Tested & Keywords

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