간호사가 류마티스 관절염으로 메토트렉세이트를 복용 중인 대상자의 전화를 검토합니다. 즉각적인 추적 관찰이 필요한 소견은 무엇입니까? 용량 오류 또는 심각한 독성과 관련된 소견을 강조 표시하세요.

Nurses' Notes 0830: The rheumatology nurse returns a call from a client who began oral methotrexate after the last clinic visit. Medication reconciliation shows that the client has taken 1 prescribed tablet every morning for six days. The original instruction in the electronic record is a weekly regimen for rheumatoid arthritis. The client reports that a phone reminder is set for the scheduled weekly dose. At 0840, the client describes several painful mouth ulcers that make eating difficult. The food record shows that soft foods and cool liquids remain tolerated throughout the day. The client also reports that a fever and sore throat began during the night. No household contact has a similar illness. The client states that unexplained bruises appeared on both forearms. The nurse confirms that folic acid is taken according to the prescription. The client says that morning joint stiffness has improved slightly. At 0850, the client reports that water intake has remained near the usual amount despite the schedule change. The client denies a new cough or shortness of breath. The nurse asks the client not to take another dose while urgent evaluation is arranged.