# A nurse is caring for a patient receiving chemotherapy who develops severe neutropenia. Which nursing intervention should be the highest priority to ensure patient safety?

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> subject: Adult Health

## 문제

A nurse is caring for a patient receiving chemotherapy who develops severe neutropenia. Which nursing intervention should be the highest priority to ensure patient safety?

## 보기

1. Encourage the patient to perform deep breathing exercises every 2 hours
2. Monitor the patient's fluid intake and output every 4 hours
3. Implement strict neutropenic precautions including protective isolation **✔ 정답**
4. Assess the patient's pain level using a standardized pain scale

**정답: 3**

## 해설

Neutropenia significantly increases infection risk. The highest priority is implementing strict neutropenic precautions to protect the patient from life-threatening infections. Other interventions are important but do not address the immediate safety threat.

## 심화 해설

Understanding the Priority: Infection Risk in Severe Neutropenia

The core of this clinical scenario is recognizing that severe neutropenia represents a state of profound immunosuppression. The absolute neutrophil count (ANC) is critically low, typically defined as an ANC below 500 cells/μL. Neutrophils are the body's primary defense against bacterial and fungal infections. Without this first line of defense, the patient is not only at high risk for infection but also unable to mount a typical inflammatory response. This means the classic signs of infection, such as purulent drainage, erythema, and localized warmth, may be absent. A low-grade fever might be the only initial sign of a life-threatening systemic infection, a condition known as febrile neutropenia (FN). Therefore, the highest priority nursing intervention is to create a safe environment that minimizes the patient's exposure to potential pathogens.

Why Strict Neutropenic Precautions Are the Priority

Implementing strict neutropenic precautions, including protective isolation, is the correct answer because it directly addresses the most immediate and lethal threat to the patient: infection. The provided evidence underscores that neutropenia significantly increases infection risk and worsens treatment outcomes [1]. A personalized nursing pathway focused on infection prevention has been shown to effectively reduce hospital-acquired infections in this vulnerable population [3]. This intervention is a primary prevention strategy. By controlling the patient's environment—enforcing rigorous hand hygiene, restricting visitors who are ill, prohibiting fresh flowers and live plants, and ensuring the patient is in a private room with high-efficiency particulate air (HEPA) filtration when indicated—the nurse actively reduces the microbial burden around the patient. This proactive approach is far more effective than trying to manage a septic event once it has already begun, especially considering that febrile neutropenia is one of the most serious yet potentially preventable complications of systemic chemotherapy [2].

Analyzing the Other Options

The other options represent important aspects of care but are not the highest priority in the context of severe neutropenia. Encouraging deep breathing exercises is a valuable intervention for preventing atelectasis and pneumonia, particularly in post-operative patients. However, for a neutropenic patient, the risk of acquiring an exogenous, life-threatening bloodstream infection from the environment is a more immediate danger than atelectasis. Monitoring fluid intake and output is a standard and crucial nursing task for patients receiving chemotherapy to assess renal function and hydration status, especially with nephrotoxic agents. However, this is an assessment and monitoring function, not a direct safety intervention that prevents the most critical threat. Finally, assessing pain is always a nursing priority for comfort and quality of life, but it does not supersede a safety intervention that prevents a potentially fatal complication. The principle of the nursing process dictates that safety and physiological integrity take precedence. Preventing sepsis through strict infection control is a foundational safety measure upon which all other care, including psychosocial support and symptom management, depends [1].References (research sources)

- [1]Optimizing nursing care for neutropenic patients: a holistic perspective on education, support, and clinical management.Research articleXu ZN, Gao LP, Wang XK, Yu XL, Cong Y, Wang PJ. (2025) · DOI: 10.3389/fmed.2025.1633708

- [2]Development and clinical validation of a nursing risk prediction model for chemotherapy-induced febrile neutropenia in patients with cancer.Research articleXie F, Zheng D, Chen N, Zhang J, Wang N, Yi Q, Wang L. (2026) · DOI: 10.3389/fcell.2026.1779406

- [3]Application of a Personalized Nursing Pathway for Infection Prevention in Hospitalized Leukemia Patients: A Single-Center Retrospective Cohort Study.Research articleLin J, Guo Q, Zhuang P, Xie X, Zheng R, Chen X. (2025) · DOI: 10.2147/tcrm.s550531

## 임상 시나리오

Neutropenic Precautions ProtocolImmediate safety actions for ANC below 500 cells/μL
Place patient in a private room with door closed to enforce protective isolation. Ensure strict hand hygiene for all staff and visitors before entry.

Remove all sources of potential pathogens: no fresh flowers, live plants, or raw foods. Ensure patient wears a surgical mask when leaving the room for procedures.

CautionA single temperature spike of 38.3°C (101°F) is a medical emergency (febrile neutropenia). Do not wait for other signs of infection like pus or redness, as the patient cannot mount an inflammatory response.

## 핵심 개념

- **Severe Neutropenia** — A condition defined by an absolute neutrophil count (ANC) below 500 cells/μL, resulting in profound immunosuppression and high risk for infection.
- **Febrile Neutropenia** — A medical emergency in a neutropenic patient characterized by a single oral temperature of ≥38.3°C (101°F) or a sustained temperature of ≥38.0°C (100.4°F) for over an hour, often the only sign of a life-threatening infection.
- **Protective Isolation** — A set of infection control practices designed to protect an immunocompromised patient from environmental pathogens, including a private room, strict hand hygiene, and restrictions on visitors and fresh plants.
- **Absolute Neutrophil Count (ANC)** — A calculation of the total number of mature and immature neutrophils in a blood sample, used to assess a patient's risk for infection; calculated as WBC × (% neutrophils + % bands).

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