A 19-year-old boy with a history of seizure disorder presents to the nurse practitioner with symptoms of a high fever, a macular rash, and pharyngitis. He says he thinks he has strep throat, but the rapid test is negative for Streptococcus infection. This patient was started on phenytoin 2 months ago. Which of the following is the most likely explanation for his symptoms?
Drug reaction with eosinophilia and systemic symptoms (DRESS syndrome)
Phenytoin-induced gingival enlargement (PIGE)
Phenytoin-induced toxic epidermal necrolysis (TEN)
Purple glove syndrome
The Correct Answer is A
Choice A reason: DRESS syndrome is a severe drug-induced hypersensitivity reaction that typically occurs 2–8 weeks after starting a medication like phenytoin. It presents with fever, rash, lymphadenopathy, pharyngitis, and internal organ involvement. The timing and constellation of symptoms in this patient strongly suggest DRESS.
Choice B reason: Gingival enlargement is a known side effect of phenytoin but presents as painless gum overgrowth, not systemic symptoms like fever or rash. It does not explain the acute illness described.
Choice C reason: Toxic epidermal necrolysis is a life-threatening skin reaction characterized by widespread epidermal detachment and mucosal involvement. While it can be caused by phenytoin, the patient’s rash is macular and not consistent with the extensive skin sloughing seen in TEN.
Choice D reason: Purple glove syndrome is a rare complication of intravenous phenytoin administration, involving painful swelling and discoloration of the limb. It does not occur with oral phenytoin and does not match the patient’s symptoms.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Individuals with fair skin, light hair, and light eyes are at higher risk for melanoma. However, brown hair and brown eyes are not considered high-risk features. This statement is inaccurate and may mislead the patient.
Choice B reason: This explanation reflects current understanding that sunscreen use may give a false sense of security, leading to prolonged sun exposure. Additionally, many sunscreens primarily block UVB rays, while UVA rays—which penetrate deeper into the skin—can still contribute to melanoma risk. This statement provides a scientifically grounded rationale.
Choice C reason: While there is some correlation between higher socioeconomic status and increased melanoma rates due to lifestyle factors like frequent sun exposure, this explanation is indirect and not the most accurate or helpful for the patient.
Choice D reason: Although improper sunscreen application or failure to reapply can reduce protection, this statement is speculative and lacks the broader context of UVA exposure and behavioral patterns associated with sunscreen use.
Correct Answer is B
Explanation
Choice A reason: This describes changes more typical of asthma or chronic bronchitis, not emphysema. Emphysema involves destruction of alveolar walls rather than mucosal thickening or epithelial desquamation.
Choice B reason: Emphysema is characterized by permanent enlargement of airspaces distal to the terminal bronchioles due to destruction of alveolar walls. Smoking triggers an inflammatory response that activates proteases like elastase, which degrade alveolar structures, leading to reduced surface area for gas exchange and loss of elastic recoil. This results in irreversible airflow obstruction.
Choice C reason: This describes the pathophysiology of asthma, which involves reversible airway obstruction due to inflammation, mucus plugging, and bronchial smooth muscle contraction. Emphysema does not involve mucus plug formation or reversible obstruction.
Choice D reason: This describes the mechanism of acute respiratory distress syndrome (ARDS), not emphysema. ARDS involves alveolar-capillary membrane damage due to infection or trauma, leading to fluid leakage and decreased lung compliance.
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