# A client with sickle cell anemia takes hydroxyurea. Today the absolute neutrophil count is 1,800/mm3. Which action should the nurse take?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=513821&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A client with sickle cell anemia takes hydroxyurea. Today the absolute neutrophil count is 1,800/mm3. Which action should the nurse take?

## Option

1. Hold hydroxyurea and notify the prescriber for blood-count and dose management. **✔ Correct answer**
2. Administer hydroxyurea because neutropenia is the intended therapeutic endpoint.
3. Give the dose with an iron supplement to raise the neutrophil count.
4. Double the next dose if the medication is held today.

**Correct answer: 1**

## Explanation

The Droxia label defines neutrophils below 2,000/mm3 as a toxic-range blood count and directs interruption until recovery, followed by dose reduction as indicated.

## In-depth explanation

Quick answer
Hold hydroxyurea and notify the prescriber because the neutrophil count is in the labeled toxic range.

Why this is correct
Hydroxyurea can cause severe myelosuppression. The Droxia dosing table identifies neutrophils below 2,000/mm3 as toxic and recommends interruption with frequent reassessment until recovery.

Easy analogy or mental picture
The blood count is the safety gate for the next dose. When the neutrophil gate is below the labeled threshold, the medication waits.

Memory hook
Hydroxyurea plus ANC below 2,000/mm3: interrupt and reassess.

NCLEX decision rule
Review the current complete blood count before administration. When a labeled hold threshold is reached, prevent further exposure and notify the authorized prescriber for follow-up and dose management.

Why the other choices are wrong
Neutropenia is not a goal to ignore. Iron does not acutely correct medication-related neutropenia, and doubling a later dose would increase toxicity.References
1DailyMed: DroxiaBlood-count thresholds and temporary interruption

## Clinical scenario

Myelosuppression check
Trend neutrophils, platelets, hemoglobin, reticulocytes, symptoms of infection, last dose, and the current hydroxyurea plan.

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