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 D
Explanation
Choice A reason: This question is designed to assess for manic or hypomanic episodes, where decreased need for sleep is a hallmark symptom. While related to sleep, it is more specific to mood disorders and not a general sleep assessment.
Choice B reason: This question targets hallucinations and is part of the psychosis screening. It does not relate to sleep patterns or quality.
Choice C reason: This question assesses for dissociative symptoms, such as amnesia or identity disturbances. It is unrelated to sleep.
Choice D reason: This question directly addresses sleep adequacy and quality, making it the most appropriate for evaluating the sleep domain in a psychiatric ROS. It helps identify insomnia, hypersomnia, or other sleep disturbances.
Correct Answer is B
Explanation
Choice A reason: H2 receptor antagonists such as ranitidine and famotidine are effective for mild GERD symptoms, but they are not considered first-line for moderate to severe GERD. PPIs are preferred due to their superior acid suppression and healing rates for erosive esophagitis.
Choice B reason: The American College of Gastroenterology recommends initiating PPI therapy once daily before the first meal of the day for GERD management. PPIs reduce gastric acid secretion by inhibiting the H+/K+ ATPase pump in parietal cells, providing effective symptom relief and mucosal healing.
Choice C reason: While some PPIs have undergone scrutiny for long-term safety concerns (e.g., risk of kidney disease, osteoporosis, and infections), they have not been widely recalled. Most remain approved and in use under proper clinical guidance.
Choice D reason: H2 receptor agonists do not exist; the correct term is H2 receptor antagonists. Moreover, they are less effective than PPIs for healing erosive GERD and maintaining remission, especially in severe cases.
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