The nurse is caring for a client diagnosed with psoriasis vulgaris who is receiving a psoralen and ultraviolet A light (PUVA) treatment. Which assessment finding indicates that the client has been overexposed to the treatment?

Choice A reason: Thick skin plaques topped by silvery white scales are characteristic findings in psoriasis vulgaris itself and do not indicate overexposure to PUVA treatment. These plaques are a result of rapid skin cell turnover and are typically the target of treatment, not a side effect of overexposure. Choice B reason: The requirement for sunglasses because sunlight hurts the eyes is not a specific indication of overexposure to PUVA treatment. While PUVA therapy can increase sensitivity to light, the use of sunglasses is a preventive measure and does not necessarily indicate overexposure. Choice C reason: Brown, rough, greasy, wart-like papules on the face suggest the presence of seborrheic keratosis or another benign skin condition, not overexposure to PUVA treatment. These lesions are unrelated to the therapy and do not serve as an indicator of overexposure. Choice D reason: Tenderness upon palpation and generalized erythema are signs of overexposure to PUVA treatment. Overexposure can lead to phototoxic reactions, resulting in skin irritation, redness, and tenderness. These symptoms indicate that the client has received too much UV radiation during the treatment, leading to an adverse reaction.