A client with Crohn disease arrives for ustekinumab with fever, productive cough, night sweats, and a new upper-lobe infiltrate. Which action should the nurse take?
1Administer ustekinumab now and give an antipyretic so the scheduled biologic dose is not delayed.
2Give a live vaccine and the biologic simultaneously to determine whether the cough improves.
3Hold ustekinumab and obtain prompt evaluation for active serious infection, including tuberculosis.✓ Correct answer
4Reassure the client that night sweats and the upper-lobe infiltrate are expected evidence of a biologic response.
Explanation
Symptoms and imaging suggest a potentially serious infection and possible tuberculosis. Ustekinumab should not be given until the infection is evaluated and adequately treated.
Quick answer Screen active infection before further immunosuppression.
Why this is correct Clients are evaluated for tuberculosis before treatment and require prompt reassessment if infection findings appear during therapy.
Easy analogy or mental picture Use a closed medication-safety loop: identify the immune or cytotoxic exposure, connect the new findings, interrupt further harm, stabilize the client, and verify the response over time.
Memory hook Exposure, immune effect, organ toxicity, infection risk, immediate action, and serial reassessment.
NCLEX decision rule Choose the action that reduces the most immediate medication-related risk while preserving diagnostic evaluation and authorized treatment.
Why the other choices are wrong Options that continue the exposure, treat only one symptom, or delay reassessment leave the toxic or infectious process active.
Oncology, transplant, and biologic safety reviewVerify the indication, immune status, infection screen, interacting medicines, current organ findings, authorized action, and measurable follow-up.