# 一位患有克隆氏症的病人前來接受ustekinumab治療，出現發燒、咳痰、夜間盜汗和新的上葉浸潤。護理師應採取哪項措施？

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

## 題目

一位患有克隆氏症的病人前來接受ustekinumab治療，出現發燒、咳痰、夜間盜汗和新的上葉浸潤。護理師應採取哪項措施？

## 選項

1. 現在施打ustekinumab並給予退燒藥，以免延遲預定的生物製劑劑量。
2. 同時給予活疫苗和生物製劑，以確定咳嗽是否改善。
3. 暫停ustekinumab並迅速評估是否存在活動性嚴重感染，包括結核病。 **✔ 正確答案**
4. 安慰病人，夜間盜汗和上葉浸潤是生物製劑反應的預期證據。

**正確答案: 3**

## 解析

症狀和影像學檢查提示可能存在潛在的嚴重感染和結核病。在感染得到評估和充分治療之前，不應給予ustekinumab。

## 深入解析

快速解答
在進一步免疫抑制前篩查活動性感染。

為何這是正確的
病人在治療前會接受結核病評估，如果在治療期間出現感染徵象，需要迅速重新評估。

簡單類比或心像
使用封閉式藥物安全循環：識別免疫或細胞毒性暴露、連結新發現、中斷進一步傷害、穩定病人，並隨時間驗證反應。

記憶點
暴露、免疫效應、器官毒性、感染風險、立即行動和連續再評估。

NCLEX決策規則
選擇能降低最直接藥物相關風險，同時保留診斷評估和授權治療的措施。

為何其他選項是錯誤的
繼續暴露、僅治療單一症狀或延遲再評估的選項會使毒性或感染過程持續活躍。References
1DailyMed: STELARA (ustekinumab)嚴重感染、結核病評估、暫停治療、過敏反應和神經毒性

## 臨床情境

腫瘤學、移植和生物製劑安全審查
驗證適應症、免疫狀態、感染篩查、相互作用藥物、當前器官發現、授權行動和可測量的後續追蹤。

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