# A client with Crohn disease arrives for ustekinumab with fever, productive cough, night sweats, and a new upper-lobe infiltrate. Which action should the nurse take?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522606&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A client with Crohn disease arrives for ustekinumab with fever, productive cough, night sweats, and a new upper-lobe infiltrate. Which action should the nurse take?

## Option

1. Administer ustekinumab now and give an antipyretic so the scheduled biologic dose is not delayed.
2. Give a live vaccine and the biologic simultaneously to determine whether the cough improves.
3. Hold ustekinumab and obtain prompt evaluation for active serious infection, including tuberculosis. **✔ Correct answer**
4. Reassure the client that night sweats and the upper-lobe infiltrate are expected evidence of a biologic response.

**Correct answer: 3**

## Explanation

Symptoms and imaging suggest a potentially serious infection and possible tuberculosis. Ustekinumab should not be given until the infection is evaluated and adequately treated.

## In-depth explanation

Quick answer
Screen active infection before further immunosuppression.

Why this is correct
Clients are evaluated for tuberculosis before treatment and require prompt reassessment if infection findings appear during therapy.

Easy analogy or mental picture
Use a closed medication-safety loop: identify the immune or cytotoxic exposure, connect the new findings, interrupt further harm, stabilize the client, and verify the response over time.

Memory hook
Exposure, immune effect, organ toxicity, infection risk, immediate action, and serial reassessment.

NCLEX decision rule
Choose the action that reduces the most immediate medication-related risk while preserving diagnostic evaluation and authorized treatment.

Why the other choices are wrong
Options that continue the exposure, treat only one symptom, or delay reassessment leave the toxic or infectious process active.References
1DailyMed: STELARA (ustekinumab)Serious infection, tuberculosis evaluation, withholding therapy, hypersensitivity, and neurologic toxicity

## Clinical scenario

Oncology, transplant, and biologic safety review
Verify the indication, immune status, infection screen, interacting medicines, current organ findings, authorized action, and measurable follow-up.

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