A patient has been taking trimethoprim-sulfamethoxazole (TMP/SMX) ...

[Redwolflake15]

A patient has been taking trimethoprim-sulfamethoxazole (TMP/SMX) for 14 days. The patient calls the primary care nurse practitioner (NP) to report fever, rash, and enlarged lymph nodes. The NP should suspect:
 
  a. serum sickness reaction.
  b. immediate sensitivity reaction.
  c. cytotoxic hypersensitivity reaction.
  d. cell-mediated hypersensitivity reaction.

Question 2

A patient tells the primary care NP about having difficulty giving presentations at work. The patient experiences anxiety and often feels faint or vomits. The NP should:
 
  a. prescribe buspirone.
  b. prescribe alprazolam.
  c. order a selective serotonin reuptake inhibitor (SSRI) antidepressant.
  d. recommend cognitive-behavioral therapy.

[karmakat49]

Answer to Question 1

A
Serum sickness reaction can occur days to weeks after administration of the drug and is characterized by fever, rash, and lymphadenopathy. Immediate sensitivity reaction includes anaphylaxis, urticaria, and angioedema and occurs within 30 minutes of drug administration. Cytotoxic hypersensitivity reaction causes hemolytic anemia, neutropenia, and thrombocytopenia and develops 7 to 14 days after drug administration. Cell-mediated hypersensitivity reaction causes maculopapular rash, Stevens-Johnson syndrome, and toxic epidermal necrolysis and takes 48 to 72 hours to develop.

Answer to Question 2

D
The patient is describing a phobic disorder. Cognitive-behavioral therapy is recommended as first-line treatment, with SSRI medications as adjunct therapy.

[Redwolflake15]

TYSM

[momolu]

Excellent