# 情境 30歲非典型肺炎個案開始doxycycline 100 mg PO BID。最重要的個案衛教為何?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375244&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

情境 30歲非典型肺炎個案開始doxycycline 100 mg PO BID。最重要的個案衛教為何?

## 選項

1. 為最佳吸收與牛奶及制酸劑同服。
2. 為易於吞嚥磨碎藥片。
3. 為避免食道刺激，採直立姿勢配整杯水服用；與乳製品/Ca/Mg/Fe/Zn/制酸劑/bismuth相隔2小時；因光敏感使用防曬；懷孕與8歲以下避免；完成完整療程；嚴重腹瀉/黃疸/頭痛立即回報。 **✔ 正確答案**
4. 咳嗽改善即停藥。

**正確答案: 3**

## 解析

Doxycycline為四環素類抗生素，用於非典型肺炎(黴漿菌、披衣菌、退伍軍人桿菌)、蜱媒疾病(萊姆病、洛磯山斑點熱)、披衣菌、MRSA皮膚軟組織、瘧疾預防、痤瘡等。教學重點：(1) 多價陽離子明顯降低吸收 — 與乳製品、鈣、鎂、鐵、鋅、含鋁制酸劑、sucralfate、bismuth subsalicylate相隔2小時；(2) 為預防藥物性食道炎與潰瘍，配整杯水並維持直立30分鐘；(3) 光敏感常見 — 防曬、防護衣、避免日曬與日曬機；(4) 因鈣結合在發育中的骨骼與牙齒，造成永久黃褐色變色與琺瑯質發育不全並可能延遲骨骼生長，故懷孕與8歲以下兒童禁用；(5) 胃腸副作用 — 噁心、嘔吐、腹瀉；嚴重或血便提示C. difficile須回報；(6) 高劑量或懷孕中肝毒性；(7) 顱內壓上升(偽性腦瘤) — 嚴重頭痛、視力模糊、視乳頭水腫須回報；(8) 長期使用可能念珠菌感染；(9) 交互作用 — warfarin(INR上升)、digoxin(濃度上升)、口服避孕藥(可能效果降低)、retinoids(顱內壓相加)。牛奶/制酸劑、提早停藥、磨碎皆非優先。

## 深入解析

一杯水加直立加陽離子2小時分隔加上防曬加上懷孕/兒童避免為doxycycline衛教重點。藥物性食道炎與牙齒變色為高頻考點。

## 重要概念

- **doxycycline** — 四環素類，非典型肺炎/萊姆/披衣菌，懷孕/8歲以下禁用，光敏感
- **pill esophagitis** — 直立、整杯水、doxycycline/KCl/BIS等於食道滯留可造成潰瘍
- **tetracycline tooth staining** — 與發育牙齒鈣結合，永久黃褐色，懷孕與8歲以下禁忌

## 相同主題題目

- [A nurse is caring for an alert adult client with type 1 diabetes who reports tremors, swea…](https://mymerci.kr/pages/nclex_q.php?qn_id=360524&lang=zh-tw)
- [A 68-year-old client with COPD is admitted with shortness of breath and SpO2 86% on room a…](https://mymerci.kr/pages/nclex_q.php?qn_id=362940&lang=zh-tw)
- [A 58-year-old client arrives at the emergency department with crushing substernal chest pa…](https://mymerci.kr/pages/nclex_q.php?qn_id=362976&lang=zh-tw)
- [A 72-year-old client is brought to the emergency department by family who report that the …](https://mymerci.kr/pages/nclex_q.php?qn_id=363003&lang=zh-tw)
- [A 79-year-old client is admitted from a long-term care facility with diarrhea, decreased o…](https://mymerci.kr/pages/nclex_q.php?qn_id=363089&lang=zh-tw)
- [A 76-year-old female with chronic heart failure and atrial fibrillation receives digoxin 0…](https://mymerci.kr/pages/nclex_q.php?qn_id=374883&lang=zh-tw)
- [A 70-year-old client on long-term digoxin therapy reports new yellow-green halos around li…](https://mymerci.kr/pages/nclex_q.php?qn_id=374884&lang=zh-tw)
- [A 58-year-old client with type 2 diabetes mellitus and migraine prophylaxis is taking prop…](https://mymerci.kr/pages/nclex_q.php?qn_id=374893&lang=zh-tw)

## 以其他語言閱讀

- [en](https://mymerci.kr/pages/nclex_q.php?qn_id=375244&lang=en)
- [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=375244&lang=ko)
- [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=375244&lang=ja)
- [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=375244&lang=zh-tw)
- [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=375244&lang=vi)

---

More free questions: [NCLEX-RN 題庫](https://mymerci.kr/pages/nclex_bank.php?lang=zh-tw)

_僅供學習參考。實際臨床請遵循最新指引與所屬機構規範。_