# Review the changing vesicular-rash pattern and determine how infection-control measures should change.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=546624&lang=en  
> language: en  
> subject: Standard/Transmission-Based Precautions/Surgical Asepsis  
> category: SIPC

## Question

Review the changing vesicular-rash pattern and determine how infection-control measures should change.

| Time | Data |
| --- | --- |
| Admission | Afebrile; grouped vesicles are confined to the right T8 dermatome and can be fully covered; no lesions elsewhere. |
| Hospital day 2, 0800 | Temperature 38.2°C; new vesicles are present on the left forearm and scalp outside the original dermatome. |
| Hospital day 2, 1000 | Additional scattered vesicles appear on the trunk and left thigh; one unprotected staff entry occurred before the spread was recognized. |

Q1. How should the nurse interpret the change?

Possible disseminated herpes zoster
Expected healing of localized zoster
Allergic contact dermatitis
Localized bacterial cellulitis

Q2. Which infection-control response is the priority?

Continue lesion coverage without changing room placement
Initiate Airborne plus Contact Precautions and arrange AIIR placement
Use Droplet Precautions only
Delay isolation until the viral test returns

Q3. What additional action is appropriate?

Leave the room door open for observation
Encourage routine hallway ambulation
Notify infection prevention and identify susceptible exposures
Remove all coverings from draining lesions

## Explanation

A unilateral dermatomal eruption that becomes widespread is no longer localized zoster. New lesions in noncontiguous areas with fever indicate possible disseminated herpes zoster, which can spread through contact with vesicular fluid and airborne particles. The nurse should initiate Airborne plus Contact Precautions, arrange an airborne infection isolation room, cover lesions when feasible, notify infection prevention, and review susceptible exposures. Transport should be limited to medically necessary purposes with source-control measures according to policy.

## In-depth explanation

Correct Answer
The trend indicates progression from localized to disseminated herpes zoster.

Why It Fits
New vesicles appear outside the original dermatome and are accompanied by systemic symptoms.

Clinical Picture
Disseminated zoster requires both airborne and contact controls rather than lesion coverage alone.

Memory Link
Zoster beyond one dermatome changes the air and contact plan.

NCLEX Rule
Suspected disseminated herpes zoster is managed with Standard, Airborne, and Contact Precautions until lesions are dry and crusted and the diagnosis is clarified.

Why the Alternatives Fail
Continuing only routine room placement, opening the door, or delaying precautions for laboratory confirmation permits avoidable exposure.

Sources
1CDC Transmission-Based Precautions
2CDC Varicella-Zoster Virus Infection Control
3NCSBN 2026 NCLEX-RN Test Plan

## Clinical scenario

Medical unit
An immunocompetent adult is admitted with a painful vesicular eruption limited to the right T8 dermatome. The lesions are covered. The nurse monitors for progression while antiviral treatment is started.

## Key concepts

- **Dermatome** — An area of skin supplied primarily by sensory fibers from one spinal nerve root.
- **Disseminated herpes zoster** — Varicella-zoster reactivation with lesions extending beyond the primary or adjacent dermatomes, raising airborne and contact transmission concerns.
- **AIIR** — An airborne infection isolation room designed to contain infectious airborne particles.

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