# A patient on day 8 of induction chemotherapy for acute myeloid leukemia has an absolute neutrophil count of 250/uL and develops a single oral temperature of 38.4 degrees Celsius. Which nursing interventions should be implemented as part of the neutropenic fever bundle? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=372846&lang=en  
> language: en  
> subject: Safety and Infection Prevention and Control  
> category: SIPC

## Question

A patient on day 8 of induction chemotherapy for acute myeloid leukemia has an absolute neutrophil count of 250/uL and develops a single oral temperature of 38.4 degrees Celsius. Which nursing interventions should be implemented as part of the neutropenic fever bundle? Select all that apply.

1

Reinforce strict hand hygiene with all visitors and staff, and screen visitors for active infectious symptoms before entry.

2

Administer the prescribed empiric broad-spectrum antibiotic such as cefepime or piperacillin-tazobactam within 60 minutes of the febrile recognition.

3

Obtain a rectal temperature every 2 hours using a dedicated thermometer to detect fever spikes earlier than oral measurements in neutropenic patients.

4

Draw two sets of blood cultures (one peripheral and one from each lumen of the central venous catheter) prior to administering antibiotics whenever feasible.

5

Place the patient in a private room with neutropenic precautions: no fresh flowers, no raw produce, and dedicated patient-care equipment.

## Explanation

Febrile neutropenia is a sepsis-equivalent emergency: blood cultures from peripheral and central sites, broad-spectrum antibiotic within 60 minutes, neutropenic precautions (no fresh flowers, no raw produce, no rectal temperatures or suppositories due to mucosal breach risk), and strict hand hygiene. Rectal temperatures are contraindicated because they can introduce GI flora through fragile rectal mucosa.

## In-depth explanation

The 60-minute antibiotic rule for febrile neutropenia is analogous to the sepsis Hour-1 bundle. Cultures first when possible, then antibiotic within an hour. Avoid any procedure that breaches mucosa: rectal temps, suppositories, enemas, and routine indwelling urinary catheters are out. Protective environment is added on top of standard precautions.

## Clinical scenario

**Day 8 of AML induction chemotherapy**. ANC is **250/uL** (severe neutropenia) and the patient has just spiked an oral temperature of **38.4 degrees C**. Vital signs are otherwise stable. The on-call oncology team has been notified.

## Key concepts

- **Febrile neutropenia** — ANC less than 500/uL (or expected to fall below 500) plus a single oral temperature of 38.3 C or sustained 38.0 C for one hour.
- **Empiric antipseudomonal therapy** — Broad-spectrum antibiotic such as cefepime, piperacillin-tazobactam, or meropenem within 60 minutes of fever recognition.
- **Neutropenic precautions** — Private room, hand hygiene, no fresh flowers or raw produce, no rectal temperatures or suppositories, dedicated equipment.

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