A nurse is caring for a client diagnosed with systemic scleroderma five years 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?

Choice A rationale
While emotional concerns are important to address in a holistic care approach, they are not the initial course of action when a client is admitted due to an acute exacerbation of ulcerative colitis. Emotional concerns are usually addressed once the client’s physical condition is stabilized.
Choice B rationale
Checking the client’s perianal skin integrity is a crucial initial step when a client is admitted due to an acute exacerbation of ulcerative colitis. Ulcerative colitis can cause rectal bleeding and diarrhea, which can lead to skin breakdown in the perianal area. Therefore, assessing for skin integrity helps in early detection and management of potential skin complications.
Choice C rationale
Obtaining a dietary history from the client is important but not the initial course of action in this scenario. Dietary history is usually obtained once the client’s condition is stabilized and when planning for discharge or dietary modifications.
Choice D rationale
Reviewing the client’s electrolyte values is important in managing ulcerative colitis, but it’s not the initial course of action. Electrolyte imbalances can occur due to diarrhea and

malabsorption, which are common in ulcerative colitis. However, this is usually done after initial physical assessments and stabilization of the client.

Choice A rationale
While dietary iron restrictions can contribute to iron-deficiency anemia, they are not typically a symptom of ulcerative colitis. Ulcerative colitis is an inflammatory bowel disease that primarily affects the colon and rectum, and its symptoms are generally related to inflammation and damage in these areas.
Choice B rationale
Chronic blood loss is a common symptom of ulcerative colitis and a major contributing factor to the development of anemia in these patients. This is because the inflammation and ulceration in the colon and rectum can lead to bleeding, which over time can result in a significant loss of red blood cells.
Choice C rationale
Frequent diarrhea is a common symptom of ulcerative colitis, but it does not directly contribute to the development of anemia. However, severe or prolonged diarrhea can lead to malnutrition and malabsorption of nutrients, including iron, which could indirectly contribute to anemia.
Choice D rationale

Abdominal pain is a common symptom of ulcerative colitis, but it does not directly contribute to the development of anemia. The pain is typically caused by inflammation and ulceration in the colon and rectum, not by a loss of red blood cells.