A client with a urinary tract infection started trimethoprim-sulfamethoxazole 10 days ago and has taken no other new medications. Today the client reports a fever of 38.8°C (101.8°F), sore throat, painful eyes, and a rash that began on the face and trunk and is spreading. The nurse notes dusky red macules with atypical target lesions and several flaccid blisters covering about 8% of the body surface area; gentle lateral pressure causes the epidermis to slide off. There is conjunctival redness, lip swelling with crusting, and several oral erosions. No lymph node enlargement or facial edema is present, the eosinophil count is normal, and there is no history of recent cold sores. Blood pressure is 108/66 mm Hg and heart rate 112/min. Complete the diagram by selecting the condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

Quick answer
Stevens-Johnson syndrome; stop trimethoprim-sulfamethoxazole and notify the provider for urgent burn-unit care; monitor percent body surface area detached and hourly urine output.

Why this is correct
The timing (about 1 to 3 weeks after a high-risk drug), fever, mucosal erosions at more than one site, dusky atypical target lesions, and epidermis that slides with gentle pressure (positive Nikolsky sign) with detachment under 10% fit Stevens-Johnson syndrome. Outcomes improve when the culprit drug is withdrawn early. Denuded skin loses fluid, protein, and heat much like a burn, so care in a burn or intensive care setting with close fluid monitoring is needed.

Easy analogy or mental picture
Imagine the skin as wallpaper whose glue is dissolving: the top layer slides under a fingertip, and every bare patch leaks fluid like a burn.

Memory hook
"Mucosa + sliding skin + new drug = stop it and treat it like a burn."

NCLEX decision rule
For a spreading rash with mucosal erosions after a new drug, withdraw the drug immediately and escalate; monitor the extent of skin loss and fluid balance.

Why the other choices are wrong
Topical steroids and antihistamines treat mild eruptions and allow the culprit drug to continue. Continuing the drug while waiting for a biopsy lets detachment progress. DRESS is less likely with normal eosinophils, no lymphadenopathy, and no facial edema; erythema multiforme major usually follows herpes simplex with typical acral targets; staphylococcal scalded skin syndrome spares the mucous membranes. Eosinophil count and ALT track DRESS, and IgE tracks type I allergic reactions rather than SJS progression.