A client who began taking allopurinol 5 days ago reports a new widespread rash with peeling skin and painful sores in the mouth. Which instruction should the nurse provide?
1Continue allopurinol and take an antihistamine until the next appointment
2Stop allopurinol and seek immediate medical evaluation for the reaction✓ Correct answer
3Skip the next dose and resume a lower dose when the rash begins to fade
4Apply moisturizer and report the rash only if a fever later develops
Explanation
Allopurinol should be stopped at the first sign of a rash. Peeling skin and oral sores raise concern for a severe cutaneous reaction, so the client needs immediate medical evaluation rather than self-treatment or dose adjustment.
Quick answer Stop allopurinol and seek immediate evaluation. The skin peeling and oral sores suggest a potentially severe drug reaction.
Why this is correct Allopurinol can cause serious hypersensitivity and severe skin reactions. The prescribing information directs discontinuation at the first appearance of a rash, and mucosal involvement or peeling increases the urgency of assessment.
Easy analogy or mental picture A new rash on allopurinol is like smoke from an electrical panel: disconnect the source and investigate promptly. The picture emphasizes early action, but it does not diagnose the exact reaction or replace emergency clinical assessment.
Memory hook Allopurinol plus a new rash means stop the drug and evaluate promptly.
NCLEX decision rule When a medication is associated with severe cutaneous reactions and a client reports a new rash, follow the drug-specific stop instruction and escalate concerning features. Do not advise unsupervised rechallenge or dose reduction.
Why the other choices are wrong An antihistamine or moisturizer can mask symptoms while the reaction progresses. Briefly skipping and then restarting exposes the client again, and waiting for fever delays evaluation of already serious findings.
References
[1]
NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing
[2]
DailyMed: Allopurinol Tablets Prescribing InformationU.S. National Library of Medicine