A nurse is collecting data from a client who has scleroderma. Which of the following findings should the nurse expect?

Choice A rationale Salivary gland dysfunction in scleroderma typically leads to xerostomia, which is an abnormally dry mouth, rather than excessive salivation. The underlying pathology involves fibrotic changes and collagen deposition within the connective tissues of the salivary glands, which eventually leads to glandular atrophy and decreased fluid production. This lack of lubrication complicates swallowing and increases the risk of dental caries. Consequently, increased salivation is not a clinical feature of this systemic autoimmune disorder. Choice B rationale Scleroderma is characterized by structural changes in the skin rather than a dry raised rash. While inflammatory conditions like psoriasis or certain forms of dermatitis present with raised plaques or rashes, scleroderma involves the overproduction of collagen within the dermis. This leads to the thickening and tightening of the skin. Although early stages might involve some localized swelling or erythema, the classic presentation is smooth, shiny skin that feels tethered to the underlying structures. Choice C rationale Hardened skin is the hallmark clinical finding of scleroderma, resulting from the excessive accumulation of extracellular matrix proteins, primarily collagen. This process starts with edema but progresses to skin induration and sclerosis. The skin often appears tight and waxy, losing its normal elasticity. This fibrosis can limit joint mobility and cause contractures, especially in the hands. This manifestation occurs due to an autoimmune trigger that activates fibroblasts to produce excessive fibrous connective tissue. Choice D rationale Periorbital edema is more commonly associated with renal conditions like nephrotic syndrome or inflammatory states rather than scleroderma. In scleroderma, the facial skin usually becomes taut and mask-like because of the hardening process, which pulls the skin tight over the facial bones. This tightening actually reduces the appearance of wrinkles and limits the ability to open the mouth wide. Edema around the eyes does not align with the fibrotic pathology that defines this specific disease.