Điều dưỡng xem xét cuộc gọi từ một bệnh nhân đang dùng methotrexate điều trị viêm khớp dạng thấp. Những phát hiện nào cần theo dõi ngay lập tức? Đánh dấu các phát hiện liên quan đến sai sót liều dùng hoặc độc tính nghiêm trọng.

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.