# 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=540957 > 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. Mucosal involvement with painful erosions in the mouth and conjunctiva **✔ 정답** 2. Symmetric erythematous rash on both lower extremities 3. Raised, itchy wheals distributed across the trunk 4. Localized vesicular lesions following a dermatome pattern **정답: 1** ## 해설 Mucosal involvement with painful erosions is the hallmark of SJS, distinguishing it from other rashes. Other options describe conditions like erythema multiforme (symmetric rash), urticaria (itchy wheals), or herpes zoster (dermatomal lesions). ## 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 Practice Guide When assessing a patient with suspected SJS: 1. Notify HCP! Immediately report to the attending physician and recommend discontinuing all current medications (including prescriptions, over-the-counter drugs, and herbal medicines). 2. Critical Cue: Systematically assess the oral, conjunctival, nasal, and genital mucosa. Check for oral blisters, ulcers, bleeding, and difficulty swallowing. 3. Evaluate the extent of skin detachment. Check for Nikolsky's sign (skin peeling with gentle friction) and estimate the percentage of body surface area (BSA) involvement (SJS: 30%). 4. Closely monitor vital signs, hydration status (skin turgor, mucosa, urine output), and respiratory status (potential airway mucosal involvement). Caution: In SATA (Select All That Apply) questions, there may be distractor options that list only the appearance of the skin rash (target lesions, scales) as signs of SJS without including mucosal involvement. Remember that a diagnosis of SJS is difficult to make without mucosal involvement. Additionally, the timing of onset (1-3 weeks after starting a drug) is an important clue. ## 핵심 개념 - **Stevens-Johnson Syndrome** — A severe, potentially life-threatening skin and mucous membrane reaction triggered by drugs or infections. It is characterized by widespread epidermal necrosis, detachment, and involvement of mucous membranes such as the mouth, eyes, and genitals. - **Mucosal Erosion** — Loss of the mucosal surface layer causing pain, bleeding, and difficulty swallowing. In SJS/TEN, it occurs on the oral, conjunctival, nasal, and genital mucosa and has high diagnostic importance. - **Toxic Epidermal Necrolysis** — A more severe form than SJS, a severe drug reaction where more than 30% of the body surface area undergoes skin detachment. SJS and TEN are considered to be on the same disease spectrum. - **Nikolsky Sign** — A phenomenon where the epidermis easily peels off when normal-appearing skin is lightly rubbed or pulled. It is a diagnostic sign seen in conditions such as pemphigus, SJS, and TEN. - **Drug Reaction with Eosinophilia and Systemic Symptoms** — Another severe hypersensitivity syndrome caused by drugs. It is characterized by rash, fever, internal organ involvement, and eosinophilia, and must be distinguished from SJS/TEN. ## 같은 주제 문제 - [A nurse is assessing a patient with suspected Stevens-Johnson syndrome (SJS). Which assess…](https://mymerci.kr/pages/nclex_q.php?qn_id=540955) - [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 caring for a patient with Stevens-Johnson syndrome (SJS). Which nursing interve…](https://mymerci.kr/pages/nclex_q.php?qn_id=540958) - [A nurse is caring for a patient diagnosed with Stevens-Johnson syndrome (SJS). Which nursi…](https://mymerci.kr/pages/nclex_q.php?qn_id=540959) - [A nurse is caring for a patient with Stevens-Johnson syndrome (SJS). 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