# A nurse is assessing a patient with suspected Stevens-Johnson syndrome (SJS). Which assessment finding would be most indicative of this condition? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=540955 > language: ko > subject: Adult Health ## 문제 A nurse is assessing a patient with suspected Stevens-Johnson syndrome (SJS). Which assessment finding would be most indicative of this condition? ## 보기 1. Widespread skin detachment with positive Nikolsky's sign and mucosal involvement **✔ 정답** 2. Localized erythematous rash with well-defined borders and no systemic symptoms 3. Pustular lesions with surrounding erythema confined to hair follicles 4. Symmetric scaling patches with silvery appearance on extensor surfaces **정답: 1** ## 해설 Stevens-Johnson syndrome is characterized by widespread skin detachment with positive Nikolsky's sign and mucosal involvement, distinguishing it from other skin conditions. Other options describe localized rashes, pustular lesions, or scaling patches not typical of SJS. ## 심화 해설 Clinical Judgment This question assesses the ability to identify the key clinical signs of Stevens-Johnson Syndrome (SJS), a severe drug-induced skin reaction. The key point is that SJS is not a simple skin rash but a systemic illness involving the mucous membranes, requiring you to Notify HCP!. Option 1, "Mucosal involvement with painful erosions in the mouth and conjunctiva," is the Critical Cue for SJS. Painful erosions in the mouth and conjunctiva pose a direct risk to the patient's swallowing, nutritional intake, and vision, and are a warning sign of progression to toxic epidermal necrolysis (TEN). The other options represent different conditions (e.g., venous stasis dermatitis of the lower extremities, urticaria, herpes zoster) and are thus distinguished from SJS. Memory Tip: When remembering SJS, think of the mnemonic: **S**tevens-Johnson **S**yndrome = **S**erious **S**loughing of **S**kin & **S**lime membranes (mucous membranes). Alternatively, you can emphasize that mucosal involvement is essential with "**M**ucosal **M**ust **M**atter." KR vs US: In Korea, anticonvulsants and allopurinol tend to be emphasized more as causative drugs for SJS/TEN, whereas in the US NGN, comprehensive awareness of all potential triggering drugs (sulfonamides, NSAIDs, antibiotics, etc.) and the importance of verifying the medication history are equally stressed. Additionally, in US nursing practice, when assessing mucosal involvement (especially oral), the oral intake amount is quantitatively documented along with the pain score, and the need for an urgent ophthalmology consultation is more actively emphasized. ## 임상 시나리오 Clinical Assessment for Stevens-Johnson Syndrome When assessing a patient for suspected Stevens-Johnson syndrome (SJS), a systematic approach is critical. The hallmark findings are widespread skin detachment, a positive Nikolsky's sign, and severe mucosal involvement. Mucosal erosions, often affecting the oral, ocular, and genital areas, are present in over 90% of cases and may precede skin lesions. **Key Assessment Technique:** To test for Nikolsky's sign, apply gentle lateral pressure with your thumb on an area of seemingly normal skin adjacent to a lesion. A positive sign is indicated by the skin wrinkling and shearing off, leaving a moist, painful erosion. This reflects pathological separation at the dermal-epidermal junction. The differential diagnosis should include other severe cutaneous adverse reactions (SCARs) and conditions like erythema multiforme, staphylococcal scalded skin syndrome, and acute graft-versus-host disease. A thorough medication history is essential, focusing on common triggers such as sulfonamides, beta-lactam antibiotics, anticonvulsants, and NSAIDs. Early recognition and immediate discontinuation of the offending agent are paramount to improving outcomes. ## 핵심 개념 - **Nikolsky's sign** — A dermatological sign where gentle lateral pressure on normal-appearing skin causes the upper epidermal layers to shear off, indicating a disruption at the dermal-epidermal junction. - **Stevens-Johnson syndrome (SJS)** — A rare, life-threatening, immune-mediated mucocutaneous disorder characterized by extensive keratinocyte apoptosis, leading to widespread epidermal detachment and severe mucosal erosions. - **Keratinocyte apoptosis** — Programmed cell death of keratinocytes, the primary cell type in the epidermis, which is the central pathophysiological mechanism in SJS and toxic epidermal necrolysis. ## 같은 주제 문제 - [A nurse is assessing a 28-year-old patient who was admitted with suspected Stevens-Johnson…](https://mymerci.kr/pages/nclex_q.php?qn_id=540956) - [A nurse is assessing a patient with suspected Stevens-Johnson syndrome (SJS). 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