The nurse is reviewing risk factors for cholelithiasis in a client’s history. Which factor most significantly increases the client’s risk for developing gallstones?

Choice A reason: Topical corticosteroids reduce inflammation, scaling, and itching in psoriasis by inhibiting pro-inflammatory cytokines and immune responses in affected skin. They are first-line for plaque psoriasis with silvery scales, effectively managing burning and promoting healing of inflamed, bleeding areas on elbows and palms.

Choice B reason: Topical analgesics relieve pain but do not address psoriasis’s underlying inflammation or scaling. Psoriatic plaques are primarily inflammatory, not neuropathic. Analgesics may reduce burning temporarily but lack the anti-inflammatory action of corticosteroids, making them ineffective for managing chronic psoriatic lesions.

Choice C reason: Topical antibiotics treat bacterial infections, not psoriasis, which is an autoimmune inflammatory condition. Bleeding in psoriasis results from skin fragility, not infection. Antibiotics are unnecessary unless secondary infection is confirmed, making them inappropriate compared to corticosteroids, which target the disease’s inflammatory pathology.

Choice D reason: Colloidal oatmeal-based lotion soothes irritated skin and reduces itching but lacks anti-inflammatory properties to treat psoriasis’s scaling and inflammation. It may provide symptomatic relief but is inadequate for managing chronic plaques, unlike corticosteroids, which directly address the autoimmune-driven inflammation and scaling.

Choice A reason: HIV does not primarily cause a deficiency in antibody production. B-cells produce antibodies, but HIV targets CD4 T-cells, impairing their ability to activate B-cells. This indirectly reduces antibody effectiveness, but the primary mechanism is T-cell destruction, not a direct antibody production deficit, making this incorrect.

Choice B reason: HIV infects and destroys helper T-cells (CD4 cells), critical for coordinating immune responses. By reducing CD4 cell counts, HIV impairs activation of B-cells and cytotoxic T-cells, leading to immune suppression. This is the primary mechanism of AIDS-related immune deficiency, making it the correct explanation for HIV pathology.

Choice C reason: Proliferation of suppressor T-cells (regulatory T-cells) is not a primary HIV mechanism. HIV depletes CD4 cells, not suppressor T-cells, which modulate immune responses. While immune dysregulation occurs, the hallmark is CD4 destruction, not suppressor T-cell proliferation, making this an inaccurate description of HIV’s action.

Choice D reason: HIV does not increase B-lymphocyte numbers. It impairs B-cell function indirectly by destroying CD4 cells, which are needed to activate B-cells for antibody production. B-cell hyperactivity may occur in early HIV, but the primary immune suppression results from CD4 cell loss, not B-cell proliferation.