# 一位患有糖尿病和慢性腎衰竭的老年人正在開始使用含 isoniazid 的結核病治療方案。護理師應預期哪項處方能減少可預測的神經學不良反應？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=516671&lang=zh-tw  
> language: zh-TW  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## 題目

一位患有糖尿病和慢性腎衰竭的老年人正在開始使用含 isoniazid 的結核病治療方案。護理師應預期哪項處方能減少可預測的神經學不良反應？

## 選項

1. 維生素 K 以預防耳毒性。
2. 碳酸鈣以預防視神經炎。
3. 葉酸以預防紅人症候群。
4. 吡哆醇以降低周邊神經病變的風險。 **✔ 正確答案**

**正確答案: 4**

## 解析

老年、糖尿病和慢性腎衰竭會增加對 isoniazid 相關周邊神經病變的易感性；建議對有神經病變風險因素的個案使用吡哆醇。

## 深入解析

快速解答
預期這位高風險個案isoniazid 併用吡哆醇。

為什麼這是正確的
Isoniazid 可能導致劑量相關的周邊神經病變。CDC 資料指出，糖尿病、腎衰竭、高齡、HIV、懷孕、酗酒和營養不良等風險狀態下會使用維生素 B6 補充劑。

簡單類比或心像
在刺痛途徑受損之前，加上維生素護欄。

記憶點
INH 加上神經病變風險：考慮 B6。

NCLEX 決策規則
評估基線感覺、肝臟症狀、依從性、交互作用以及完整的結核病治療方案，而不是單獨衛教一種不良反應。

為什麼其他選項是錯誤的
維生素 K、鈣和葉酸不能預防此處描述的典型 isoniazid 神經病變機制。References
1CDC: Treatment of Latent TB Infection and TB Disease ModuleIsoniazid neuropathy risk and pyridoxine for clients with risk factors

## 臨床情境

Isoniazid 衛教
審查神經病變風險、吡哆醇、肝臟警示症狀、避免飲酒、依從性、藥物交互作用和結核病追蹤。

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