A nurse is caring for a client receiving chemotherapy who develops severe neutropenia with an absolute neutrophil count (ANC) of 450 cells/mm³. Which nursing intervention should be the highest priority?

Severe neutropenia (ANC < 500 cells/mm³) requires immediate neutropenic precautions, including private room placement, to prevent life-threatening infections. Other interventions are important but secondary to infection prevention.

Core Nursing Explanation Key Concept Analysis: This question tests the priority nursing intervention for a patient with severe neutropenia secondary to chemotherapy. Neutropenia is a critical decrease in neutrophils, the body's primary defense against bacterial and fungal infections. The Absolute Neutrophil Count (ANC) is the key lab value. An ANC of 450 cells/mm³ falls into the category of severe neutropenia (ANC < 500 cells/mm³), which carries a very high risk for life-threatening infections. The core nursing principle here is Infection Prevention as the highest priority, based on the ABCs (Airway, Breathing, Circulation) and Maslow's Hierarchy of Needs, where safety from infection is a fundamental physiological and safety need.

Answer Rationale: Key Point! The correct answer is placing the client in a private room and initiating neutropenic precautions. This is the priority because it directly addresses the most immediate and life-threatening risk: infection. For a patient with an ANC < 500, standard neutropenic precautions include a private room (or a room with another neutropenic patient), strict hand hygiene for all who enter, prohibiting sick visitors, avoiding fresh flowers/plants, and ensuring a low-microbial diet. This intervention is proactive and protective.

Distractor Analysis:
Watch out for confusion! Option ② (Administer antiemetic) addresses a common and distressing side effect of chemotherapy (nausea/vomiting), but it is not the highest priority when a life-threatening condition like severe neutropenia is present. Managing symptoms is important but secondary to preventing a fatal infection.
Option ③ (Encourage fluids) is a standard supportive measure for patients receiving chemotherapy to maintain hydration and support renal function, especially with nephrotoxic drugs. However, it does not address the acute, severe risk posed by the critically low ANC.
Option ④ (Monitor platelets) is relevant for another common chemotherapy complication: thrombocytopenia. While monitoring for bleeding risk is important, the question specifically identifies the problem as severe neutropenia. The priority intervention must directly correlate with the identified problem. Monitoring platelets is an assessment, not an immediate protective intervention for the neutropenic state.

Related Concepts: Understanding the calculation of ANC (ANC = WBC x (%Segs + %Bands) / 100) is crucial. The severity of neutropenia is graded: Mild (ANC 1000-1500), Moderate (500-1000), Severe (

Nursing Clinical Practice Guide Clinical Scenario: You are the nurse on an oncology unit. Your patient, Mr. Jones, who is on day 7 post-chemotherapy for leukemia, has a temperature of 38.5°C (101.3°F). His morning lab results show: WBC 1.2 K/µL, Neutrophils 8%, Bands 2%. You quickly calculate his ANC: (1.2 x (8+2))/100 = 0.12 x 1000 = 120 cells/mm³. This is severe neutropenia with fever.

Nursing Intervention Strategy: 1. Immediate Action (Priority): Notify the provider STAT. This is febrile neutropenia, an emergency. While awaiting orders, move the patient to a private room if not already in one. Initiate strict neutropenic precautions. 2. Assessment: Perform a thorough head-to-toe assessment, paying close attention to subtle signs of infection (e.g., mucosal changes, skin breakdown, lung sounds, perianal area). Avoid rectal temperatures or suppositories. 3. Implementation: Anticipate orders for blood cultures (from two different sites, usually peripheral), urine culture, chest X-ray, and immediate administration of broad-spectrum IV antibiotics. Maintain strict aseptic technique for all line care. 4. Patient/Family Education: Teach the patient and family about neutropenic precautions at home: meticulous hand hygiene, avoiding crowds, wearing a mask in public, cooking foods thoroughly, and reporting any fever >38°C (100.4°F) immediately.

Patient Safety and Precautions: Never delay antibiotic administration for cultures if drawing blood is difficult. Administer antibiotics within one hour of fever recognition in a neutropenic patient. Be vigilant for signs of sepsis (tachycardia, tachypnea, hypotension).
Nursing Procedure & Medication Flow Neutropenic Precautions (Protective Isolation) Procedure: 1. Room: Private room with positive air pressure (if available). Door should remain closed. 2. Hand Hygiene: Meticulous handwashing with soap and water or alcohol-based gel by EVERYONE before entering and after leaving. 3. PPE: Staff and visitors should not enter if they have any contagious symptoms (cough, cold, etc.). 4. Environment: No fresh flowers, plants, or standing water. Daily cleaning of high-touch surfaces. 5. Patient Care: Daily bathing with antimicrobial soap. Meticulous oral care. No raw fruits/vegetables (low-microbial diet).

A Word from Your Senior Nurse: "In oncology nursing, your vigilance with lab values like the ANC is what saves lives. A fever in a neutropenic patient isn't just a fever—it's a five-alarm fire until proven otherwise. Your priority is always to protect them from what their body can no longer fight. When you see that ANC < 500, think 'private room and protect' before anything else. This instinct, grounded in pathophysiology, is what makes you an excellent nurse."