# The nurse reviews a follow-up note for a client who recently started allopurinol. Which findings require immediate follow-up? Highlight the findings associated with a serious hypersensitivity reaction. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=494737&lang=en > language: en > subject: Medication Administration > category: PPT ## Question The nurse reviews a follow-up note for a client who recently started allopurinol. Which findings require immediate follow-up? Highlight the findings associated with a serious hypersensitivity reaction. Nurses' Notes 0910: The client began allopurinol 100 mg daily 8 days ago for recurrent gout. The client reports that a red rash began on the trunk and is spreading to both arms. The affected knee is less tender than it was at the previous visit. Yesterday's uric acid level was lower than the pretreatment value. At 0830, the client measured a temperature of 38.6 °C. The nurse observes new facial edema with fever and malaise. The client reports drinking water regularly unless otherwise instructed. During the interview, the client states that urine remains clear yellow without dysuria. The oral examination shows painful mouth erosions with burning eyes. The client had mild nausea for 10 minutes after breakfast yesterday. Medication reconciliation confirms the prescribed dose was taken once each morning. The client denies shortness of breath at rest. The right great toe has no warmth or new swelling today. The client asks whether the next refill can be synchronized with other medications. The nurse notes that the pharmacy label and daily instructions match the active prescription. No new injury was reported. ## Explanation A spreading rash, fever with facial edema, and painful oral or eye involvement require immediate evaluation. These findings can signal severe allopurinol hypersensitivity rather than an expected gout flare. ## In-depth explanation Quick answer Highlight the spreading rash, fever with facial swelling, and painful mouth erosions with burning eyes. Allopurinol should be stopped and the client urgently evaluated when a rash or other hypersensitivity signs appear. Why this is correct Allopurinol can rarely cause severe reactions such as Stevens-Johnson syndrome, toxic epidermal necrolysis, or DRESS. A new widespread rash plus fever, facial edema, or mucosal injury points beyond a routine gout flare and can progress quickly.[2] Easy analogy or mental picture Think of a rash as a smoke alarm. A small alarm still requires stopping to check, and smoke in several rooms, such as skin, face, mouth, or eyes, suggests a larger fire. The analogy supports early escalation but does not diagnose a specific reaction by itself. Memory hook New rash first; fever, face, or mucosa make the danger louder. NCLEX decision rule For a newly started medication with a labeled severe skin warning, prioritize new rash and systemic or mucosal findings over expected therapeutic effects or mild isolated gastrointestinal symptoms. Hold the suspected medication and escalate rather than giving the next dose. Why the other choices are wrong Lower uric acid, improving joint tenderness, adequate fluid intake, taking the prescribed dose, and a brief mild nausea episode do not form the displayed hypersensitivity pattern. Early gout flares can occur after treatment starts, but they do not explain fever, facial edema, and mucosal injury.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 ## Related questions - [Before giving a scheduled dose of digoxin, the nurse obtains an apical pulse of 54/min in …](https://mymerci.kr/pages/nclex_q.php?qn_id=374883&lang=en) - [An older adult taking digoxin reports nausea, poor appetite, and yellow-green halos. 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