A nurse is caring for a client who has ulcerative colitis and is receiving sulfasalazine. Which of the following findings requires immediate intervention?

A. Jaundice. Jaundice, or yellowing of the skin and eyes, is a sign of liver dysfunction and may indicate hepatotoxicity rather than an allergic reaction. Some medications can cause drug-induced liver injury (DILI), but jaundice is not a typical symptom of an immediate hypersensitivity reaction.

B. Urticaria. Urticaria (hives) is a classic allergic reaction that appears as raised, red, itchy welts on the skin. It occurs due to the release of histamine in response to an allergen, which increases capillary permeability and leads to swelling and itching. Urticaria may be accompanied by angioedema, respiratory distress, or anaphylaxis, requiring immediate intervention if severe.

C. Bradycardia. Bradycardia (slow heart rate) is not a typical manifestation of an allergic reaction. While anaphylaxis can cause hypotension and tachycardia due to systemic vasodilation, bradycardia is more commonly associated with beta-blockers, heart block, or vagal stimulation rather than an allergic response.

D. Hypertension. Allergic reactions, especially severe ones like anaphylaxis, typically cause vasodilation and hypotension, not hypertension. While stress or anxiety related to an allergic episode may lead to a temporary rise in blood pressure, persistent hypertension is not a direct sign of an allergic reaction.

A. Cover the administration area with plastic wrap. After applying nitroglycerin ointment, the area should be covered with plastic wrap or a transparent dressing to prevent evaporation and ensure proper absorption through the skin. This also helps prevent the medication from accidentally transferring to another person or clothing.

B. Massage the ointment into the skin. Nitroglycerin ointment should not be massaged into the skin, as this can cause rapid absorption and lead to hypotension and dizziness due to vasodilation. Instead, it should be applied as a thin, even layer and covered with a dressing.

C. Spread the ointment in a 10 cm² (4 in²) area. The correct application method involves measuring the exact prescribed amount (e.g., using the applicator paper) and applying it in a thin layer. The area of application may vary based on the dosage, but the focus should be on accurate measurement, not a specific area size.

D. Apply the ointment in a thick layer. A thick application is unnecessary and could increase absorption too quickly, leading to side effects such as headache, dizziness, and hypotension. Instead, a measured dose should be spread thinly and evenly onto clean, dry skin.