A client who received cytotoxic chemotherapy 9 days ago has an oral temperature of 38.5°C and an absolute neutrophil count of 360/mm³. Complete the emergency plan.
Drop-down Cloze
Choose your responses, then check the answer.
Explanation
Fever with profound neutropenia is febrile neutropenia and can progress rapidly even before hypotension develops. Obtain the ordered cultures promptly, including appropriate catheter and peripheral specimens, but do not delay empiric treatment. Administer the prescribed broad antipseudomonal antibiotic within 1 hour of triage and continue close monitoring for sepsis and hemodynamic deterioration.
Correct Answer Recognize febrile neutropenia, obtain ordered cultures without delaying treatment, and administer the prescribed empiric antipseudomonal antibiotic within 1 hour.
Why It Fits Profound neutropenia can blunt local signs of infection. Stable blood pressure does not make the fever low risk.
Clinical Picture Cultures help identify the organism, but the antimicrobial clock starts at triage because deterioration can be rapid.
Memory Link Culture promptly, but never culture slowly enough to delay the first antibiotic.
NCLEX Rule Treat fever with profound neutropenia as an oncologic emergency and monitor for sepsis even when the initial vital signs are stable.
Why the Alternatives Fail Waiting for final cultures or visible pus delays treatment. Antifungal monotherapy, routine follow-up, or a live vaccine does not address the immediate bacterial risk.
Sources
1ASCO/IDSA Fever and Neutropenia Guideline
22026 NCLEX-RN Test Plan
The client is in oncology triage with stable blood pressure and a central venous catheter. Ordered cultures and empiric antimicrobial therapy can begin immediately.
Neutropenic Fever — Fever in a client with low neutrophils, requiring urgent infection evaluation.
Absolute Neutrophil Count — A measure of neutrophil defense against bacterial infection.
Broad-Spectrum Antibiotic — An antimicrobial selected to cover likely organisms before culture results return.