Choice A rationale:

Pregnant women should receive the Tdap vaccine during each pregnancy. This is a correct statement as vaccination during pregnancy helps provide protection to both the mother and the newborn against tetanus, diphtheria, and pertussis.

Choice B rationale:

The recommended vaccination schedule for adults includes a single dose of Tdap (tetanus, diphtheria, and acellular pertussis) vaccine, followed by a Td (tetanus and diphtheria) booster every 10 years. Three doses of DTP vaccine during adulthood are not part of the recommended schedule.

Choice C rationale:

Tetanus prophylaxis should be given to patients with all types of wounds, not just severe wounds. This statement is incorrect.

Choice D rationale:

The Tdap vaccine is not administered every 5 years during adulthood. As mentioned earlier, adults receive a single dose of Tdap and then a Td booster every 10 years.

Choice A rationale:

The nurse should not advise the patient to apply iodine, hydrogen peroxide, or alcohol to the wound. These substances can be irritating to the wound and delay the healing process.

Choice B rationale:

Cleaning and debriding the wound as soon as possible is an essential action to prevent infection and promote healing. Removing debris and foreign material from the wound reduces the risk of contamination and infection.

Choice C rationale:

Using non-sterile instruments for wound care is not appropriate. The nurse should emphasize the importance of using clean and sterile instruments to prevent introducing additional bacteria into the wound.

Choice D rationale:

Administering the Td vaccine (Tetanus and Diphtheria) for prophylaxis is a crucial action to protect the patient from tetanus, especially in contaminated wounds where tetanus spores might be present.

Choice E rationale:

Proper disposal of animal feces is crucial to avoid exposure to tetanus spores. Tetanus spores can be found in soil contaminated with animal feces and can enter the body through open wounds, leading to a serious and potentially fatal infection.

Choice A rationale:

Chickenpox and shingles are viral infections, and while they can cause systemic symptoms, they are not directly linked to heart disease.

Choice B rationale:

The complications of chickenpox go beyond bacterial skin infections. While bacterial superinfections are possible, the more severe complications are associated with the virus itself.

Choice C rationale:

Shingles is characterized by a localized rash along the distribution of a sensory nerve, not a generalized vesicular rash.

Choice D rationale:

Complications of both chickenpox and shingles include pneumonia, encephalitis (inflammation of the brain), and postherpetic neuralgia (persistent nerve pain following shingles) These complications can be serious and require medical attention.

Choice A rationale:

The primary infection of VZV occurs through respiratory droplets, not when a person comes into contact with them. The virus is highly contagious and spreads through respiratory secretions.

Choice B rationale:

Reactivation of VZV in the nerve cells leads to the onset of shingles, not chickenpox. Chickenpox is the primary infection, and after recovery, the virus remains dormant in nerve cells and can reactivate as shingles later in life.

Choice C rationale:

The incubation period of VZV for chickenpox ranges from 10 to 21 days, which is accurate information.

Choice D rationale:

The risk of transmission during reactivation (shingles) is higher than during primary infection (chickenpox) Shingles can cause the development of vesicles containing the virus, which can be contagious if someone comes into direct contact with the fluid from the vesicles. Primary chickenpox, on the other hand, spreads through respiratory droplets and is more widespread during the initial infection.

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.

Choice A rationale:

Airborne precautions are used for infectious agents that spread through small respiratory droplets and remain suspended in the air for long periods. Shingles is not transmitted through the airborne route.

Choice B rationale:

Droplet precautions are used for infectious agents that spread through large respiratory droplets and have a limited range. Shingles is not transmitted through large respiratory droplets.

Choice C rationale:

This is the correct response. Contact precautions are implemented for patients with shingles (herpes zoster) because the virus spreads through direct contact with the rash or lesions.

Choice D rationale:

Standard precautions are used for all patients to prevent the transmission of infections from both recognized and unrecognized sources. However, for specific diseases like shingles, additional precautions like contact precautions are also required.

Choice A rationale:

Varivax is not administered as a single dose during adulthood. The vaccine is given as two doses, usually separated by 4 to 8 weeks, to ensure adequate protection.

Choice B rationale:

Varivax can reduce the risk of developing shingles, especially in individuals who had chickenpox and received the vaccine. While it may not completely prevent shingles, it can lessen its severity.

Choice C rationale:

This is the correct response. Varivax is a live attenuated vaccine, which means it contains weakened forms of the varicella-zoster virus that causes chickenpox. It stimulates the immune system to produce a protective response without causing the disease.

Choice D rationale:

Varivax is not recommended only for healthcare workers. It is recommended for certain groups, including children, adolescents, and adults who have not had chickenpox or received the vaccine. Healthcare workers might be among the targeted groups due to their increased risk of exposure, but it is not limited to them.

Choice A rationale:

Encouraging using sterile instruments for cutting umbilical cords is important in preventing tetanus as contaminated instruments can introduce the

C. tetani spores, leading to infection.

Choice B rationale:

Promoting safe delivery practices in clean facilities is crucial to prevent tetanus in newborns. Clean delivery facilities reduce the risk of exposure to

C. tetani spores, which can enter through unclean delivery practices.

Choice C rationale:

Advising against disposing of animal feces properly is not directly related to preventing tetanus. Tetanus is primarily caused by the introduction of

C. tetani spores into wounds, not through exposure to animal feces.

Choice D rationale:

Educating on avoiding contact with soil or feces that may contain

C. tetani spores is essential in preventing tetanus. The spores can be found in soil and feces, and direct contact with these sources increases the risk of infection.

Choice E rationale:

Suggesting regular booster doses of DTP vaccine during adulthood is an effective measure in preventing tetanus. The DTP vaccine provides immunity against tetanus, and regular boosters are recommended to maintain protection throughout life.

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 B rationale:

Bell's palsy is a known complication of shingles (herpes zoster) The varicella-zoster virus (VZV), which causes chickenpox, remains dormant in the body and can reactivate as shingles later in life. Shingles can affect the facial nerve, leading to Bell's palsy, characterized by facial muscle weakness or paralysis on one side of the face.

Choice D rationale:

Postherpetic neuralgia is another complication associated with shingles. It is a persistent, severe pain that continues after the rash has healed, caused by nerve damage during the shingles infection. Choices A, C, and E rationales: Congestive heart failure (choice A), chronic obstructive pulmonary disease (choice C), and acute pancreatitis (choice E) are not directly related to shingles. These conditions are not commonly known as complications of shingles or the varicella-zoster virus infection.

Choice A rationale:

The nurse should recommend applying calamine lotion to soothe and dry the chickenpox lesions. Calamine lotion has a soothing effect on the skin and can help reduce the itching associated with chickenpox. It also helps to dry out the lesions, which may aid in the healing process. However, it is essential to advise the family not to apply calamine lotion on open sores or areas with broken skin to avoid potential irritation.

Choice B rationale:

Giving aspirin to a child with chickenpox is not recommended. Aspirin has been associated with an increased risk of Reye's syndrome in children with viral infections, including chickenpox. Reye's syndrome is a rare but potentially life-threatening condition that affects the brain and liver.

Choice C rationale:

Antiviral drugs, such as acyclovir, are often prescribed for severe cases of chickenpox or for individuals at high risk of complications. These drugs can help shorten the duration of the illness and reduce the severity of symptoms. They are not to be avoided to prevent side effects, as the benefits generally outweigh the potential risks.

Choice D rationale:

Allowing the child to play outside may not be the best approach to distract them from itching. It is crucial to prevent the child from scratching the rash to avoid secondary bacterial infections and scarring. Engaging the child in indoor activities and providing distractions that do not involve scratching would be a safer approach.

Choice A rationale:

Topical corticosteroids can help reduce inflammation in various skin conditions, but they are not the best option for managing pain associated with shingles (herpes zoster) Corticosteroids primarily target inflammation and do not provide effective pain relief in neuropathic pain, which is characteristic of shingles.

Choice B rationale:

Antibiotics are not useful for managing the pain caused by shingles. Shingles is a viral infection, not a bacterial one, so antibiotics would not be effective in reducing pain or preventing secondary infection.

Choice C rationale:

Starting antiviral drugs, such as acyclovir, valacyclovir, or famciclovir, within 72 hours of rash onset is essential for managing shingles. These medications can help reduce the severity and duration of the illness and may also decrease the risk of developing complications like postherpetic neuralgia.

Choice D rationale:

Topical capsaicin is an appropriate option for neuropathic pain relief in shingles. Capsaicin, derived from chili peppers, works by desensitizing the nerve endings and reducing pain signals. However, it may cause a burning sensation initially, and the client should be advised on proper application and hand hygiene afterward.

Choice A rationale:

Anemia is not a complication typically associated with shingles. Shingles is caused by the varicella-zoster virus, and it primarily affects the nerves and skin, leading to a painful rash.

Choice B rationale:

Migraine headaches are not directly related to shingles. Shingles affects sensory nerves and typically presents with localized pain and a rash along the affected nerve's pathway.

Choice C rationale:

The nurse should monitor for postherpetic neuralgia in this client. Postherpetic neuralgia is a common complication of shingles that involves persistent and severe pain in the area where the rash was present. It occurs due to nerve damage caused by the virus, and the pain can last for weeks to months after the rash has healed.

Choice D rationale:

Asthma is not a complication associated with shingles. Shingles is a viral infection that primarily affects the skin and nerves and does not involve the respiratory system.

Choice A rationale:

Complete Blood Count (CBC) is not useful in confirming the diagnosis of chickenpox. CBC provides information about the number and types of blood cells but is not specific to chickenpox diagnosis.

Choice B rationale:

Stool culture is not relevant in confirming the diagnosis of chickenpox. Stool culture is used to identify gastrointestinal infections, and it is not associated with chickenpox.

Choice C rationale:

Tzanck smear and viral culture from vesicle fluid are useful in confirming the diagnosis of chickenpox. Tzanck smear involves taking a sample from the vesicle and staining it to identify multinucleated giant cells, which are characteristic of varicella-zoster virus (VZV) infection. Viral culture involves growing the VZV in a lab to confirm the presence of the virus.

Choice D rationale:

Urinalysis is not relevant in confirming the diagnosis of chickenpox. Urinalysis is used to assess kidney function and detect urinary tract infections, but it does not help in diagnosing chickenpox.

Choice A rationale:

Taking aspirin is not recommended for individuals with chickenpox, especially children, as it has been associated with an increased risk of Reye syndrome, a severe and potentially fatal condition affecting the brain and liver.

Choice B rationale:

Applying topical antibiotics is not a suitable recommendation for relieving pruritus (itching) associated with chickenpox. Topical antibiotics are used to treat bacterial skin infections, not pruritus.

Choice C rationale:

Using antihistamines is the most appropriate recommendation for relieving pruritus in chickenpox. Antihistamines block the effects of histamine, a chemical released during an allergic reaction or infection, and can help reduce itching.

Choice D rationale:

Increasing physical activity is not advised for a client with chickenpox, as this could lead to the spread of the virus to others and may worsen the symptoms and pruritus.

Choice A rationale:

Postherpetic neuralgia is a potential complication of shingles. It occurs when nerve pain persists even after the rash has healed and can be a long-term and debilitating condition.

Choice B rationale:

Cranial nerve palsies can be a complication of shingles when the herpes zoster virus affects the cranial nerves, leading to neurological symptoms and complications.

Choice C rationale:

Bacterial superinfection is not a common complication of shingles. Shingles is caused by a viral infection, and while bacterial superinfection can occur if there is a secondary bacterial infection of the skin lesions, it is not a primary concern.

Choice D rationale:

Reye syndrome is not associated with shingles or its treatment. Reye syndrome is a rare but serious condition that primarily affects children recovering from viral infections, particularly those who have taken aspirin.

Choice E rationale:

Eye involvement is a potential complication of shingles, particularly if the herpes zoster virus affects the ophthalmic nerve, leading to eye pain, redness, and sometimes vision problems. Immediate medical attention is required in such cases to prevent complications that could lead to vision loss.

Choice A rationale:

Monitoring vital signs, fluid intake, and output is important for assessing the client's overall health and hydration status, but it does not specifically address preventing the transmission of the virus.

Choice B rationale:

Providing comfort measures like cool compresses and loose clothing can help alleviate symptoms and discomfort, but it does not directly address preventing the transmission of the virus.

Choice C rationale:

Encouraging oral hygiene and a soft diet is essential for managing the client's symptoms and promoting healing, but it does not focus on preventing the spread of the virus to others.

Choice D rationale:

Isolating the patient until all lesions are crusted over is a crucial nursing intervention to prevent transmission of the chickenpox virus. Chickenpox is highly contagious, primarily spread through respiratory droplets and contact with the fluid from the skin lesions. By isolating the patient until all lesions have crusted over, the risk of spreading the virus to others is significantly reduced.

Choice A rationale:

Monitoring vital signs, pain level, and neurological status is important to assess the client's overall condition and response to treatment.

Choice B rationale:

Isolating the patient until all lesions are crusted over is not necessary for shingles, as it is not as highly contagious as chickenpox.

Choice C rationale:

Educating the patient and family about the disease process is essential to help them understand the condition, its course, and the necessary measures for management and prevention of complications.

Choice D rationale:

Encouraging oral hygiene and a soft diet is important, especially if the patient has oral lesions, to promote comfort and prevent secondary infections.

Choice E rationale:

Administering medications as prescribed, such as antiviral medications, can help reduce the severity and duration of the shingles outbreak.

Choice A rationale:

Stating that "chickenpox is not contagious once the fever is gone" is incorrect information. Chickenpox is still contagious until all the lesions are crusted over.

Choice B rationale:

The statement "You can spread the virus by scratching the lesions" is accurate. Scratching the chickenpox lesions can cause the fluid from the blisters to be released, and this fluid contains the varicella-zoster virus, which can then infect others.

Choice C rationale:

Stating that "chickenpox can only be transmitted through respiratory droplets" is incorrect. While respiratory droplets are a common mode of transmission, direct contact with the fluid from the lesions is also a significant mode of transmission.

Choice D rationale:

Saying that "the virus can survive on surfaces for up to 24 hours" is incorrect. The varicella-zoster virus is relatively fragile and cannot survive for extended periods on surfaces outside the body. It is primarily transmitted through direct contact or respiratory droplets.

Choice A rationale:

(Incorrect) Shingles, caused by the varicella-zoster virus, can be transmitted through direct contact with the fluid from the vesicles (blisters) of a person who has active shingles. However, it is important for the nurse to provide correct information to the client.

Choice B rationale:

(Correct) Shingles can only occur in individuals who have previously had chickenpox. After a person recovers from chickenpox, the virus remains dormant in the nerve tissues. Later in life, the virus can reactivate, leading to shingles. It is crucial for the nurse to emphasize this point to prevent any misunderstandings.

Choice C rationale:

(Incorrect) While the shingles vaccine is effective in reducing the risk of developing shingles, it does not have a 100% efficacy rate. The vaccine can, however, reduce the severity and duration of the illness if shingles still occur after vaccination.

Choice D rationale:

(Incorrect) The herpes zoster vaccine (shingles vaccine) is not given to children under 10 years old. It is recommended for adults aged 50 years and older or for individuals with certain risk factors.

Choice A rationale:

(Correct) Excluding infected individuals from school or work until all lesions are crusted over is an important measure in preventing the spread of chickenpox. This helps to reduce the risk of transmission to others.

Choice B rationale:

(Correct) Practicing good hand hygiene is essential to prevent the spread of the varicella-zoster virus, which causes chickenpox and shingles. Regular handwashing helps reduce the likelihood of virus transmission through contact with contaminated surfaces or infected individuals.

Choice C rationale:

(Incorrect) Sharing personal items such as towels with infected individuals can increase the risk of spreading the virus. It is crucial for the nurse to discourage such practices during the community class.

Choice D rationale:

(Incorrect) While reporting cases of chickenpox or shingles to local health authorities is important for surveillance purposes, it is not a preventive measure for individual protection.

Choice A rationale:

(Incorrect) The herpes zoster vaccine (shingles vaccine) is not administered to patients with chickenpox. The vaccine is recommended for those aged 50 years and older to prevent shingles in individuals who have previously had chickenpox.

Choice B rationale:

(Incorrect) Encouraging contact with immunocompromised individuals is not appropriate when caring for a patient with chickenpox. Immunocompromised individuals are more susceptible to severe complications from the varicella-zoster virus, so close contact should be avoided.

Choice C rationale:

(Correct) Using cool compresses is an essential comfort measure for patients with chickenpox. Cool compresses can help soothe the itching and discomfort caused by the chickenpox rash.

Choice D rationale:

(Incorrect) Providing educational materials only to the patient is not sufficient. It is important for the nurse to educate the patient's family members or caregivers about chickenpox precautions and care to prevent further transmission of the virus.

Choice A rationale:

The varicella vaccine is not effective in preventing chickenpox. This statement is incorrect. The varicella vaccine is actually highly effective in preventing chickenpox. It contains a weakened form of the varicella-zoster virus, which stimulates the body's immune system to develop protection against the virus, reducing the risk of getting chickenpox.

Choice B rationale:

Serious adverse events from the vaccine are common. This statement is incorrect. Serious adverse events from the varicella vaccine are rare. Like all vaccines, there may be some mild side effects such as soreness at the injection site, fever, or a mild rash, but severe reactions are extremely uncommon.

Choice C rationale:

The vaccine has a high efficacy rate in preventing shingles. This statement is correct. The varicella vaccine not only helps prevent chickenpox but also reduces the risk of developing shingles later in life. Shingles is caused by the reactivation of the varicella-zoster virus, and the vaccine helps boost immunity to the virus, leading to a decreased likelihood of shingles.

Choice D rationale:

The vaccine is not recommended for pregnant women. This statement is generally correct. Pregnant women should avoid receiving the varicella vaccine because it is a live attenuated vaccine, and there is a theoretical risk of transmission to the fetus. If a woman is not immune to varicella and is planning to become pregnant, it's best to receive the vaccine before pregnancy.

Choice A rationale:

Young age. This statement is incorrect. While shingles is more common in older adults, it can still occur in individuals of any age. Young age is not a risk factor for developing shingles.

Choice B rationale:

Stress. This statement is correct. Stress weakens the immune system, making individuals more susceptible to shingles. Emotional or physical stress can trigger shingles in people who have already had chickenpox.

Choice C rationale:

Immunocompromised status. This statement is correct. Individuals with weakened immune systems, such as those with HIV, cancer, or taking immunosuppressive medications, have a higher risk of developing shingles because their bodies may have difficulty controlling the reactivation of the varicella-zoster virus.

Choice D rationale:

Trauma. This statement is correct. Physical trauma or injury to the skin can increase the risk of shingles in the affected area. The trauma can disrupt the nerve pathways and trigger the reactivation of the varicella-zoster virus.

Choice E rationale:

Allergic to gelatin or neomycin. This statement is correct. The varicella vaccine contains trace amounts of gelatin and neomycin. Individuals with severe allergies to these components should not receive the vaccine to avoid potential allergic reactions.

Tuberculosis.