# A 48-year-old client is on day 10 after induction chemotherapy for acute myeloid leukemia. The client has new rigors and weakness, temperature 38.4 C, BP 92/54 mm Hg from a baseline of 118/70, ANC 180/mm3, lactate 2.8 mmol/L, normal oxygenation, and no inflammation at the central-line site. Classify each finding by the clinical decision it supports. More than one column may apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=516657&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A 48-year-old client is on day 10 after induction chemotherapy for acute myeloid leukemia. The client has new rigors and weakness, temperature 38.4 C, BP 92/54 mm Hg from a baseline of 118/70, ANC 180/mm3, lactate 2.8 mmol/L, normal oxygenation, and no inflammation at the central-line site. Classify each finding by the clinical decision it supports. More than one column may apply.

|  | Supports chemotherapy-related neutropenia | Supports infection evaluation | Supports impaired perfusion |
| --- | --- | --- | --- |
| Day 10 after AML induction chemotherapy |  |  |  |
| Absolute neutrophil count 180/mm3 |  |  |  |
| Temperature 38.4 C with new rigors |  |  |  |
| Blood pressure 92/54 mm Hg from baseline 118/70 with unusual weakness |  |  |  |
| Lactate 2.8 mmol/L |  |  |  |

## Explanation

Day 10 after AML induction supports a chemotherapy-related nadir. ANC 180/mm3 supports both profound treatment-related neutropenia and urgent infection evaluation. Fever with new rigors supports infection evaluation. The blood-pressure decrease with unusual weakness and the elevated lactate support impaired perfusion. These classifications are based on the presented cues; no blood-culture result is required, and normal oxygenation or a clean central-line site would not exclude infection.

## In-depth explanation

Quick answer
Sort cues into host-defense failure, infection evidence, and perfusion threat.

Why this is correct
Cytotoxic therapy commonly produces a predictable neutrophil nadir. In this setting, fever drives the infection pathway, while hypotension and elevated lactate show that the physiologic consequence is already severe.

Easy analogy or mental picture
Three folders are open at once: why defenses are low, whether infection is present, and whether organs are being underperfused.

Memory hook
Chemo plus low ANC explains risk; fever suggests infection; pressure and lactate show severity.

NCLEX decision rule
Analyze each cue by the clinical decision it changes and allow one finding to support more than one decision.

Why the other choices are wrong
The absence of line erythema cannot close the infection folder because neutropenia can mute local findings.References
1IDSA: Antimicrobial Agents in Neutropenic Patients With CancerPrompt cultures, broad empiric antibacterial therapy, risk assessment, and response monitoring

## Clinical scenario

Neutropenia, infection, and perfusion analysis
Classify what explains immune risk, what triggers infection evaluation, and what signals impaired perfusion without using a clean line site to exclude bacteremia.

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