— 藥理與非經腸給藥 · MEDIUM · SATA —
一位類風濕性關節炎病人被開立滅殺除癌錠（Methotrexate）。下列哪些發現是護理師需優先回報醫師的？（選所有適合的）
A client with rheumatoid arthritis is prescribed methotrexate. Which findings should the nurse identify as priority to report to the provider? (Select all that apply.)
- APresence of dry, non-productive cough✓ 正解出現乾性、無痰之咳嗽
- BReports of frequent mouth sores (stomatitis)✓ 正解報告頻繁之口腔潰瘍（口膜炎）
- CYellowing of the sclera✓ 正解鞏膜黃染
- DIncreased energy levels after the first dose首次給藥後能量水平增加
- ELow-grade fever or sore throat✓ 正解低燒或喉嚨痛
— Explanation · 中文詳解 —
滅殺除癌錠具有免疫抑制與肝毒性。乾咳可能暗示間質性肺炎，必須評估；口腔潰瘍是常見副作用，亦可能是骨髓抑制的前兆；黃疸顯示肝功能受損；發燒或喉嚨痛則預示嚴重感染或嗜中性白血球減少。能量提升是預期的療效，非警訊。
The nurse must report a dry cough, mouth sores, yellowing of the sclera, and low-grade fever or sore throat as these indicate potential methotrexate toxicity. These symptoms may signal interstitial pneumonitis, stomatitis, hepatotoxicity, or infection due to immunosuppression, whereas increased energy is a desired therapeutic effect.
✦ 台美臨床差異
兩地皆強調用藥衛教（如定期監測肝功能），但美國護理師常主導追蹤血檢數值的提醒，台灣則多由門診個管師協助。