# 護理師檢視一名腎臟移植個案的出院用藥清單。哪一組預防用藥符合預防伺機性感染的標準照護？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391876&lang=zh-tw  
> language: zh-TW  
> subject: Standard/Transmission-Based Precautions/Surgical Asepsis  
> category: SIPC

## 題目

護理師檢視一名腎臟移植個案的出院用藥清單。哪一組預防用藥符合預防伺機性感染的標準照護？

## 選項

1. 使用trimethoprim-sulfamethoxazole預防PCP/UTI，若D+/R-則用valganciclovir預防CMV，nystatin口服懸液預防Candida，若有潛伏結核可加isoniazid；並視情況更新疫苗 **✔ 正確答案**
2. 每日靜脈注射vancomycin
3. 不需要任何預防用藥
4. 靜脈化學治療

**正確答案: 1**

## 解析

正確（2）：移植後預防包括TMP-SMX預防PCP與UTI（6-12個月）、valganciclovir預防CMV（D+/R-不相合時3-6個月）、nystatin/clotrimazole預防口咽Candida（1-3個月），潛伏結核則使用isoniazid。活性減毒疫苗禁用；不活化疫苗通常3-6個月後才考慮。（1,3,4）不正確。

## 深入解析

記憶提示 移植後預防 =「Bactrim、Valgan、Nystatin」前3-12個月。避免活性減毒疫苗（MMR、水痘、黃熱病、活性流感、口服小兒麻痺）。不活化疫苗可於3-6個月後考慮。

## 臨床情境

情境 40歲女性，腎臟移植後1週；正在進行出院前用藥核對。

## 重要概念

- **TMP-SMX預防用藥** — 預防移植受者的PCP與UTI；通常在移植後使用6-12個月。
- **Valganciclovir預防** — D+/R-（捐贈者陽性/受者陰性）移植時的口服CMV預防藥；3-6個月。
- **活性減毒疫苗禁忌** — 免疫抑制中禁用活性減毒疫苗（MMR、水痘、黃熱病、活性流感、口服小兒麻痺）。

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