一位45歲女性正接受急性骨髓性白血病的高劑量化療，其絕對嗜中性白血球計數 (ANC) 為 200/mm³。護理師進入病房時，注意到床邊桌上放著一盆新鮮的康乃馨盆栽，且病患正準備吃一顆未削皮的生蘋果。病患體溫為 37.5°C。關於嗜中性白血球低下防護隔離，護理師必須執行哪些介入？（多選題）
A 45-year-old female receiving induction chemotherapy for acute myeloid leukemia has an absolute neutrophil count (ANC) of 200/mm³. Entering the room, the nurse notices a fresh potted carnation plant on the bedside table and the patient preparing to eat an unpeeled raw apple. The patient's temperature is 37.5°C (99.5°F). Which interventions must the nurse implement related to neutropenic precautions? (Select all that apply.)
- AInstruct the family to immediately remove the potted plant and any fresh flowers from the patient's room.指示家屬立即移除盆栽及房間內的所有鮮花正確答案
- BAllow the patient to consume the raw apple only if it is thoroughly scrubbed under warm running water for a minute.僅當生蘋果在溫流水下徹底刷洗一分鐘後，才允許病患食用
- CEnsure healthcare providers use dedicated, patient-specific medical equipment (e.g., stethoscope, blood pressure cuff) kept inside the room.確保醫療人員使用專屬於該病患的醫療設備（如聽診器、血壓計壓脈帶），並放置於病房內正確答案
- DAssign the patient to a negative-pressure isolation room to filter the air inside.將病患安置於負壓隔離病房以過濾空氣
- EProhibit visitors exhibiting any subtle signs of infection, such as mild coughing or a runny nose.禁止出現任何輕微感染跡象（如輕微咳嗽或流鼻水）的探視者進入正確答案
- A指示家屬立即移除盆栽及房間內的所有鮮花
- C確保醫療人員使用專屬於該病患的醫療設備（如聽診器、血壓計壓脈帶），並放置於病房內
- E禁止出現任何輕微感染跡象（如輕微咳嗽或流鼻水）的探視者進入
本題測驗針對免疫極度低下患者的嗜中性白血球低下防護與感染控制原則（Neutropenic Precautions）。該病患的 ANC 僅有 200，完全無法抵禦感染。新鮮花卉的土壤與死水極易孳生致命的黴菌（如麴菌）與革蘭氏陰性菌（如綠膿桿菌），絕對禁止置於病房內（選項A正確）。生食蔬果表面常帶有無法完全洗淨的農業來源細菌與寄生蟲，因此嚴禁這類患者食用未削皮生果，即使刷洗過也不行，必須只提供煮熟的熟食或去皮厚核的水果（選項B錯誤）。與其他接觸隔離類似，使用單獨保留在病房內的專屬醫療器具，可避免其他病房的病原體經由聽診器被帶進來（選項C正確）。嚴禁任何有感染潛力的人員探視（選項E正確）。防護隔離病房必須是「正壓（Positive-pressure）」病房，讓相對乾淨的空氣向外流出，而非會吸入走廊空氣的負壓隔離病房（負壓是用來關結核病人的，選項D邏輯錯置）。
- A · 正確答案指示家屬立即移除盆栽及房間內的所有鮮花
盆栽植物與花瓶裡的死水藏有致命的麴菌與綠膿桿菌儲存庫，對嗜中性球低下的病患構成嚴重威脅。
- B僅當生蘋果在溫流水下徹底刷洗一分鐘後，才允許病患食用
刷洗不能保證根除表面的病原體；嗜中性白血球低下飲食明確禁止未削皮的水果與生鮮蔬菜。
- C · 正確答案確保醫療人員使用專屬於該病患的醫療設備（如聽診器、血壓計壓脈帶），並放置於病房內
使用專屬病房設備可以防止其他病患身上的微生物搭便車附著在共用聽診器上造成的交叉污染。
- D將病患安置於負壓隔離病房以過濾空氣
低白血球病患需要正壓病房以便乾淨的空氣向外推來保護他們，而負壓則會將走廊上潛在髒汙的空氣吸入。
- E · 正確答案禁止出現任何輕微感染跡象（如輕微咳嗽或流鼻水）的探視者進入
健康訪客身上輕微的感冒會引發免疫極度低下病患身上壓倒性且致命的呼吸衰竭。
保護性隔離是腫瘤科及骨髓移植病房的重要措施，但具體限制並非全球一致的絕對鐵則。以台灣醫學中心衛教為例：固定照顧者、訪客每日限 1-2 人（限制人數，而非一律禁止探視），避免鮮花與盆栽，選擇新鮮煮熟的食物、避免生食。移除病床旁的鮮花盆栽這一點，兩地做法一致。 台灣出處：臺中榮民總醫院護理部〈化學藥物治療後保護隔離注意事項〉（2026）
English explanation
This item tests neutropenic precautions and infection control principles for severely immunocompromised clients. With an ANC of only 200, this patient is essentially unable to mount any defense against infection. Fresh flowers and the soil and stagnant water in which they sit readily harbor lethal molds (such as Aspergillus) and gram-negative bacteria (such as Pseudomonas), and must absolutely not be allowed in the room (Option A is correct). The surfaces of raw fruits and vegetables often carry agricultural bacteria and parasites that cannot be reliably removed by washing, so these clients are strictly prohibited from eating unpeeled raw fruit even after scrubbing; only cooked foods or fruits with thick peels that can be removed should be served (Option B is incorrect). As with other contact-isolation strategies, using dedicated room-specific medical equipment prevents pathogens from other patients' rooms being carried in on a shared stethoscope (Option C is correct). Any visitor with potential infection must be prohibited (Option E is correct). A protective isolation room must be a positive-pressure room so that relatively clean air flows outward, not a negative-pressure room that would draw potentially contaminated corridor air inward (negative pressure is used to contain patients with tuberculosis; Option D is reversed and incorrect).
最近修訂：2026-10-05