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Immune checkpoint inhibitor (ICI)–related pneumonitis is an oncologic emergency that ranges from mild to life-threatening. In a symptomatic patient with hypoxemia and characteristic CT changes, the standard approach is to HOLD immunotherapy and initiate high-dose corticosteroids (e.g., prednisone 1–2 mg/kg/day or IV methylprednisolone for more severe presentations) after obtaining appropriate infectious work-up (viral panel, sputum cultures ± BAL if needed). Empiric antibiotics can be considered while infection is excluded, but steroids should not be delayed in a clinically convincing case. Early pulmonology involvement supports grading, bronchoscopy decisions, and oxygen/ventilatory management. Infliximab (Option C) is typically used for steroid-refractory ICI colitis, not first-line for pneumonitis; second-line agents for steroid-refractory pneumonitis include mycophenolate mofetil, IVIG, or infliximab in select scenarios, guided by specialists. Continuing ICI with minimal therapy (Option A) risks progression to respiratory failure. Outpatient deferment (Option D) is inappropriate given hypoxemia. APRN responsibilities include rapid recognition, initiation of steroids and monitoring, patient education on warning signs, and careful documentation to guide decisions about future rechallenge (generally avoided for grade ≥3).