A nurse is assessing a client who presents with a prodrome of fever, headache, malaise, anorexia, and pharyngitis. The nurse observes a generalized pruritic rash that progresses from macules to papules to vesicles to pustules to crusts, starting on the face and trunk and spreading to the extremities. The number of lesions varies from a few to hundreds. Which of the following complications should the nurse be aware of?

Choice B rationale:

The symptoms described in the scenario, such as fever, headache, malaise, anorexia, pharyngitis, and the progression of a generalized pruritic rash from macules to papules to vesicles to pustules to crusts, are indicative of varicella-zoster virus (VZV) infection, commonly known as chickenpox. Otitis media (choice B) can be a complication of chickenpox, especially in children.

Choice A rationale:

Chronic kidney disease (choice A) is not a common complication of chickenpox. It is more commonly associated with conditions like diabetes and hypertension.

Choice C rationale:

Rheumatoid arthritis (choice C) is an autoimmune condition and is not a known complication of chickenpox.

Choice D rationale:

Type 2 diabetes (choice D) is not a common complication of chickenpox. Diabetes can increase the risk of infection, but it is not directly related to chickenpox.

Choice A rationale:

Administering the Td vaccine only if the wound is severe is not the correct response. Tetanus prophylaxis is recommended based on wound type and vaccination history, not just the severity of the wound.

Choice B rationale:

This is the correct response. Tetanus prophylaxis involves giving Tetanus Immunoglobulin (TIG) for immediate protection against tetanus toxin, along with the Tetanus and Diphtheria (Td) vaccine to promote long-term immunity. The decision to administer TIG and Td vaccine depends on the patient's wound type and their vaccination history.

Choice C rationale:

Tetanus prophylaxis is necessary even if the client received the DTP vaccine in childhood. The immunity from childhood vaccines may wane over time, and tetanus prophylaxis is recommended after potential exposure to the tetanus-causing bacteria.

Choice D rationale:

Giving the Td vaccine every 5 years is not the correct approach. The recommended schedule for Td booster doses is every 10 years, not every 5 years.