A nurse is assessing a client who reports burning, stabbing pain on their right thorax. The nurse notes the presence of a unilateral vesicular rash following a dermatome. Based on these findings, which of the following is the most likely diagnosis?

Psoriasis

Herpes Zoster (Shingles)

Eczema

Contact Dermatitis

Answer and Explanation

The Correct Answer is B

A. Psoriasis. Psoriasis presents as scaly, erythematous plaques with silvery-white scales, typically on the extensor surfaces of the body, rather than a unilateral vesicular rash.

B. Herpes Zoster (Shingles). Herpes zoster (shingles) is caused by reactivation of the varicella-zoster virus. It presents as a painful, unilateral vesicular rash along a dermatome, often accompanied by burning or stabbing pain.

C. Eczema. Eczema (atopic dermatitis) presents as dry, itchy, inflamed skin, usually in a chronic and relapsing pattern, rather than a vesicular rash following a dermatome.

D. Contact Dermatitis. Contact dermatitis presents as erythematous, pruritic, and sometimes vesicular lesions, but it is not limited to a single dermatome and typically occurs in areas of direct skin exposure to an allergen or irritant.

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Correct Answer is D

Explanation

A. The surgical dressing has a small amount of serosanguinous drainage. Light serosanguinous drainage is expected postoperatively and does not require immediate intervention.
B. The patient’s hemoglobin dropped from 12 g/dL to 10 g/dL within 24 hours postoperatively. A mild drop in hemoglobin postoperatively is expected due to blood loss during surgery. This does not require immediate intervention.
C. The patient reports mild discomfort at the surgical site and rates pain as 4/10 on a pain scale. Mild discomfort is expected and can be managed with prescribed analgesics.
D. The surgical extremity is cool to touch, pale, with weak pedal pulses compared to the contralateral limb. These findings indicate impaired circulation or vascular compromise, which could suggest compartment syndrome or arterial occlusion. Immediate intervention is required to prevent limb ischemia.

A. “I will keep my cast dry and avoid inserting objects inside to scratch my skin." B. "If I notice increased swelling, numbness, or severe pain, I will elevate my leg and notify my provider immediately." C. "It's okay to use a blow dryer on a cool setting to help dry my cast if it gets wet." D. “I should expect to feel extreme pain under the cast that doesn't improve with pain medication."

Correct Answer is D

Explanation

A. “I will keep my cast dry and avoid inserting objects inside to scratch my skin.” Keeping the cast dry prevents it from softening or breaking down, which could lead to improper healing. Avoiding objects inside the cast prevents skin injuries and infections.

B. "If I notice increased swelling, numbness, or severe pain, I will elevate my leg and notify my provider immediately." Increased swelling, numbness, and severe pain can indicate compartment syndrome or impaired circulation. Elevating the leg and seeking medical attention is appropriate.

C. "It's okay to use a blow dryer on a cool setting to help dry my cast if it gets wet." A blow dryer on a cool setting can be used to help dry moisture inside the cast without causing burns or affecting the cast material.

D. “I should expect to feel extreme pain under the cast that doesn't improve with pain medication.” Extreme pain that is unrelieved by medication is abnormal and may indicate complications like compartment syndrome, infection, or pressure ulcers under the cast. The patient needs further education that severe pain should be reported immediately.

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A nurse is assessing a client who reports burning, stabbing pain on their right thorax. The nurse notes the presence of a unilateral vesicular rash following a dermatome. Based on these findings, which of the following is the most likely diagnosis?

Nursing Test Bank

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Correct Answer is D

Explanation

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Correct Answer is D

Explanation

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