The nurse is caring for a client with severe dehydration. Which of the following assessment findings requires immediate follow-up?

A. White, cheesy, curd-like patches on the buccal mucosa are characteristic of oral candidiasis (thrush), a common fungal infection of the mouth caused by Candida albicans. These patches can often be wiped off, leaving a red, raw, or bleeding surface underneath. This is the classic presentation, making this the correct answer.

B. Small, painful round ulcers on the oral mucosa describe aphthous ulcers (canker sores), which are not fungal infections. They are usually idiopathic or associated with stress, trauma, or immune factors, so this option is incorrect.

C. Clear vesicles with a red base that evolve into pustules are more consistent with herpetic lesions caused by the herpes simplex virus. They are viral, not fungal, in origin, making this incorrect.

D. Chalky white, thick raised patches on the tongue may suggest leukoplakia, which is a precancerous lesion often linked to smoking or chronic irritation. Leukoplakia is not caused by fungal infection, so this option is incorrect.

A. Furuncle is a localized bacterial infection of a hair follicle, often presenting as a small, tender, red nodule with possible pus. While furuncles can occur on the outer ear, the client’s diffuse redness, swelling, and purulent discharge along with tragus pain are more consistent with a broader infection rather than a single follicle, so this is less likely.

B. Otitis externa, also known as “swimmer’s ear,” is an infection of the external auditory canal. It often develops after swimming or prolonged moisture exposure, which explains the onset the day after swimming. Classic signs include redness, swelling, scaling, crusting of the pinna, purulent discharge, and pain that worsens with movement of the pinna or pressure on the tragus. The client’s presentation matches these hallmark features, making this the correct answer.

C. Otitis media is an infection of the middle ear, typically presenting with ear pain, fever, hearing loss, and sometimes fluid behind the tympanic membrane, but it usually does not cause pain when the pinna or tragus is touched, and the external ear often appears normal. Therefore, otitis media is unlikely.

D. Excessive cerumen (earwax buildup) can cause fullness, mild discomfort, or hearing loss, but it does not usually cause redness, swelling, purulent discharge, or pain with pinna/tragus manipulation. This rules out excessive cerumen as the cause.