A 72-year-old client is diagnosed with herpes zoster (shingles). To be most effective in arresting the infection, the nurse should anticipate administering which type of medication within the first 24 hours of the eruption?

1. A

   Oral antiviral agent

2. B

   Topical antibiotic cream

3. C

   Systemic corticosteroid

4. D

   Non-steroidal anti-inflammatory drug (NSAID)

Appeared in: NORCET 1 - 2020

Explanation

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• Herpes zoster (shingles) is a viral infection caused by the reactivation of the varicella-zoster virus.
• Oral antiviral agents, such as acyclovir, valacyclovir, and famciclovir, are the first-line treatment specifically designed to stop the virus from replicating.
• To be most effective, these medications must be started early in the course of the infection, ideally within 24 to 72 hours of the first appearance of the rash.
• Early treatment shortens the duration of the rash, lessens the acute pain, and significantly reduces the risk of developing postherpetic neuralgia (PHN), a chronic and painful complication.

Why Other Options Were Wrong

• Option B: This is incorrect because antibiotics treat bacterial infections, whereas shingles is a viral infection. An antibiotic cream would have no effect on the varicella-zoster virus.
• Option C: This is incorrect because corticosteroids primarily reduce inflammation; they do not stop viral replication. They are not the primary agent to 'arrest' the infection.
• Option D: This is incorrect because NSAIDs are analgesics and anti-inflammatory drugs. They only manage the symptoms of pain and inflammation but do not have any antiviral properties to stop the infection itself.

Related Visual

• Visual 1: Image - A typical dermatomal rash of herpes zoster (shingles), showing vesicles on an erythematous base in a unilateral band-like distribution. This helps in recognizing the clinical presentation.
• Visual 2: Diagram - The mechanism of action of antiviral drugs like acyclovir, illustrating how they are activated and incorporated into viral DNA to terminate the replication chain.

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Pharmacological management of Herpes Zoster (Shingles) in acute care settings.
• The nurse plays a critical role in assessing the rash, noting the onset time, and promptly communicating with the provider to ensure antiviral therapy is initiated within the 72-hour window.
• Patient education is a key nursing responsibility, including explaining the importance of completing the full course of antiviral medication, managing pain, and using cool compresses for lesions.
• Nurses must teach infection control measures: while shingles itself isn't contagious, the varicella-zoster virus can be transmitted to individuals who are not immune to chickenpox, causing them to develop chickenpox.

How to Approach the Question

• Identify the core clinical problem from the stem: The patient has herpes zoster (shingles), which is a viral infection.
• Understand the specific goal of the question: To find the medication that 'arrests the infection,' which means stopping the pathogen's replication.
• Analyze the drug classes in the options based on their primary mechanism of action: Antivirals fight viruses, antibiotics fight bacteria, corticosteroids reduce inflammation, and NSAIDs reduce pain/inflammation.
• Match the drug class to the pathogen and the therapeutic goal. To stop a viral infection, an antiviral agent is the correct choice.
• Evaluate the timing mentioned ('first 24 hours'), which is a critical clue reinforcing that early intervention with the primary therapeutic agent is key for efficacy.
• Conclude that the oral antiviral agent is the only option that directly targets and stops the viral replication process, fitting the question's requirement.

Concept Tested & Keywords

• Concept Tested: Pharmacological management of Herpes Zoster (Shingles)
• Stem keywords: herpes zoster, shingles, arresting the infection, first 24 hours
• Lead-in keywords: most effective
• Clinical cues: 72-year-old client (indicates higher risk for complications like postherpetic neuralgia)
• Clinical cues: first 24 hours (highlights the critical window for effective treatment)

Question ID

QZCbwVz0suJQ995DLGa-yv

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