# 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.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=395558&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

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.

The findings indicate ::선택::febrile neutropeniaexpected chemotherapy fatigueallergic rhinitisuncomplicated dehydration. The nurse should ::선택::wait for final culture identification before actingobtain ordered cultures promptly without delaying antimicrobial therapygive a live-virus vaccine before collecting specimensdischarge the client for routine diet teaching and then ::선택::delay treatment until purulent drainage appearsuse an antifungal as the only immediate therapy for every clientadminister the prescribed empiric broad antipseudomonal antibiotic within 1 hour of triagerepeat the temperature at the next scheduled clinic visit.

## 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.

## In-depth explanation

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

## Clinical scenario

The client is in oncology triage with stable blood pressure and a central venous catheter. Ordered cultures and empiric antimicrobial therapy can begin immediately.

## Key concepts

- **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.

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