# A 68-year-old client with herpes zoster (shingles) on the left side of the chest is experiencing severe pain rated 8/10. The vesicular rash appeared 3 days ago and is confined to the T4-T6 dermatome. Which nursing intervention should be the priority?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=540903  
> language: ko  
> subject: Adult Health

## 문제

A 68-year-old client with herpes zoster (shingles) on the left side of the chest is experiencing severe pain rated 8/10. The vesicular rash appeared 3 days ago and is confined to the T4-T6 dermatome. Which nursing intervention should be the priority?

## 보기

1. Apply cool, wet compresses to the affected area every 2 hours
2. Encourage the client to wear loose-fitting cotton clothing
3. Administer prescribed topical corticosteroid cream to reduce inflammation
4. Administer prescribed antiviral medication within the therapeutic window **✔ 정답**

**정답: 4**

## 해설

Administering antiviral medication within 72 hours of symptom onset is the priority to reduce viral replication, pain, and prevent postherpetic neuralgia. Other interventions provide comfort but do not address the underlying cause.

## 심화 해설

Priority Nursing Intervention for Acute Herpes Zoster Pain

The correct answer is ensure timely administration of antiviral medication.

Rationale

The priority intervention is to address the underlying pathophysiology driving the acute pain and to prevent the most debilitating long-term complication. The client is in the acute phase of herpes zoster (shingles), with a vesicular rash that appeared only 3 days ago and is confined to the T4-T6 dermatome. At this stage, the severe pain rated 8/10 is caused by active viral replication and inflammation within the sensory ganglion and peripheral nerve. The varicella-zoster virus (VZV) is directly causing tissue damage and an intense inflammatory response, which is the primary source of the nociceptive and neuropathic pain [2].

The highest priority is to halt this process as quickly as possible. Timely administration of antiviral therapy (e.g., acyclovir, valacyclovir, famciclovir) is the only intervention among the options that directly suppresses viral replication. By reducing the viral load and limiting neural damage, antivirals not only accelerate the healing of the acute rash but, more critically, are the most effective strategy to reduce the risk of developing postherpetic neuralgia (PHN) [1, 2]. PHN is the most prevalent and feared complication of herpes zoster, characterized by severe, intractable pain that persists for months or years after the rash has healed, severely compromising a patient's quality of life [1]. The window for antiviral efficacy is narrow, typically within 72 hours of rash onset; at day 3, the client is at a critical juncture where initiating therapy immediately is paramount. Delaying this intervention can lead to irreversible nerve damage and a significantly higher probability of transitioning to PHN, a condition that is notoriously difficult to manage even with multimodal analgesic regimens, including agents like pregabalin [3, 4].

The other options are supportive comfort measures that address symptoms but not the disease's root cause. Applying cool, moist compresses, wearing loose-fitting cotton clothing, and applying calamine lotion are all appropriate nursing interventions for managing localized skin discomfort, pruritus, and irritation. However, they do not suppress the viral replication that is actively destroying nerve tissue and generating the severe 8/10 pain. In the clinical reasoning hierarchy of the NCLEX-RN, an intervention that treats the etiology to prevent a serious, long-term complication (PHN) takes precedence over symptomatic relief measures. The evidence-based management of herpes zoster pain begins with aggressive antiviral treatment in the acute phase to modify the disease trajectory and prevent the development of chronic neuropathic pain syndromes [1, 2].References (research sources)

- [1]Development of an evidence-based pain management protocol and its application in patients with postherpetic neuralgia.Research articleChen W, Cheng Y, Cai Y, Hong J. (2025) · DOI: 10.1097/md.0000000000046629

- [2]A survey on the clinical practice of herpes zoster and postherpetic neuralgia management by Korean medicine doctors: towards the development of Korean medicine clinical practice guidelines.GuidelineKim B, Kim K. (2026) · DOI: 10.1186/s12906-026-05248-y

## 임상 시나리오

Clinical Priority: Acute Herpes Zoster

Situation

A 68-year-old client with a 3-day history of vesicular rash on the left chest (T4-T6 dermatome) reports severe pain (8/10). The priority is to halt active viral replication within the closing therapeutic window.

Background

Herpes zoster results from reactivation of the varicella-zoster virus in the dorsal root ganglion. Acute neuritis drives severe pain, and the risk of postherpetic neuralgia (PHN) increases with age and delayed treatment. The therapeutic window for antivirals is within 72 hours of rash onset.

Assessment

- Age > 50 years (major risk factor for PHN).

- Pain score 8/10 indicating severe acute neuritis.

- Rash onset 3 days ago (end of the 72-hour antiviral window).

- Rash confined to T4-T6 dermatome, uncomplicated presentation.

Recommendation

Administer prescribed antiviral medication (e.g., acyclovir, valacyclovir, or famciclovir) immediately. This is the only intervention that targets the underlying pathophysiology to reduce acute pain severity, accelerate crusting of lesions, and decrease the incidence and duration of PHN. Comfort measures such as cool compresses and loose clothing are adjuncts to, not substitutes for, antiviral therapy.

## 핵심 개념

- **Postherpetic Neuralgia (PHN)** — A chronic neuropathic pain condition persisting for 90 days or more after the onset of the herpes zoster rash, resulting from nerve damage during the acute infection.
- **Therapeutic Window** — The optimal period, typically within 72 hours of rash onset, during which antiviral medication is most effective in reducing viral replication and preventing complications like PHN.
- **Dermatome** — A specific area of skin innervated by sensory fibers from a single spinal nerve root; herpes zoster rash characteristically follows one or two adjacent dermatomes.

## 같은 주제 문제

- [A 68-year-old client presents to the clinic with complaints of severe burning pain along t…](https://mymerci.kr/pages/nclex_q.php?qn_id=540898)
- [A 68-year-old client presents to the clinic with complaints of severe burning pain along t…](https://mymerci.kr/pages/nclex_q.php?qn_id=540899)
- [A 72-year-old client presents to the clinic with a painful, vesicular rash on the left sid…](https://mymerci.kr/pages/nclex_q.php?qn_id=540900)
- [A 68-year-old client with herpes zoster (shingles) on the left side of the chest is experi…](https://mymerci.kr/pages/nclex_q.php?qn_id=540901)
- [A nurse is caring for a 45-year-old client diagnosed with herpes zoster (shingles) affecti…](https://mymerci.kr/pages/nclex_q.php?qn_id=540902)
- [A nurse is caring for a 72-year-old patient with herpes zoster (shingles) affecting the le…](https://mymerci.kr/pages/nclex_q.php?qn_id=540904)
- [A nurse is caring for a 65-year-old patient with herpes zoster (shingles) on the left side…](https://mymerci.kr/pages/nclex_q.php?qn_id=540905)
- [A nurse is caring for a 45-year-old patient with herpes zoster (shingles) affecting the le…](https://mymerci.kr/pages/nclex_q.php?qn_id=540906)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._