一位類風濕性關節炎病人開始使用 methotrexate，何項衛教對安全最為關鍵？
A client with rheumatoid arthritis is starting methotrexate. Which patient teaching is critical for safety?
- ATake the medication with a full glass of water用一杯滿的水送服藥物
- BAvoid exposure to large crowds and individuals with infections✓ 正解避免接觸人群及感染者
- CTake the medication exactly at bedtime準時在就寢前服用藥物
- DIncrease intake of iron-rich foods增加富含鐵質食物的攝取
Methotrexate 是一種免疫抑制劑，常用於治療類風濕性關節炎等自體免疫疾病。其主要的副作用包括骨髓抑制（導致白血球、紅血球、血小板減少）、肝毒性、肺毒性以及對生殖細胞的影響。由於其免疫抑制作用，病人對感染的抵抗力會顯著下降，因此預防感染是此藥物治療中最關鍵的衛教重點。護理師必須教導病人如何識別和避免感染源，例如遠離生病的人、避免前往人群擁擠的場所，並注意個人衛生。 臨床思路：此題考量藥物治療的安全性（safety），特別是免疫抑制劑的副作用。優先處理可能危及生命的副作用，即感染。病人教育應聚焦於如何預防感染，這是維持病人生命安全與生活品質的關鍵。
Methotrexate is an immunosuppressant commonly used to treat autoimmune diseases such as rheumatoid arthritis. Its major side effects include bone marrow suppression (leading to decreased white blood cells, red blood cells, and platelets), hepatotoxicity, pulmonary toxicity, and effects on reproductive cells. Because of its immunosuppressive action, the patient's resistance to infection is significantly reduced; therefore, infection prevention is the most critical teaching focus during therapy with this medication. The nurse must teach the patient how to recognize and avoid sources of infection, such as staying away from sick individuals, avoiding crowded places, and maintaining personal hygiene. Clinical reasoning: This question addresses the safety of drug therapy, particularly the side effects of immunosuppressants. The priority is to address potentially life-threatening side effects, namely infection. Patient education should focus on how to prevent infection, which is essential for maintaining the patient's life safety and quality of life.