# A nurse is caring for a 51-year-old patient with acute leukemia who is receiving chemotherapy. The patient reports severe bone pain rated 9/10 on the pain scale. Which assessment finding would be most concerning and require immediate intervention?

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## 문제

A nurse is caring for a 51-year-old patient with acute leukemia who is receiving chemotherapy. The patient reports severe bone pain rated 9/10 on the pain scale. Which assessment finding would be most concerning and require immediate intervention?

## 보기

1. Patient reports nausea and decreased appetite
2. Vital signs show temperature 99.2°F (37.3°C), BP 110/70 mmHg, HR 88 bpm
3. Patient appears restless and requests frequent position changes
4. Petechiae observed on arms and legs with platelet count of 15,000/μL **✔ 정답**

**정답: 4**

## 해설

Petechiae with platelet count 15,000/μL indicates severe thrombocytopenia requiring immediate intervention to prevent life-threatening bleeding. Other findings like nausea, mild fever, or restlessness are expected in leukemia/chemotherapy but less urgent.

## 심화 해설

Understanding the Clinical Context

This patient with acute leukemia is undergoing chemotherapy, which places them in a profoundly immunocompromised and pancytopenic state. The report of severe bone pain (9/10) is a common and expected finding in acute leukemia due to marrow expansion by malignant cells, and while it requires management, it does not represent the most immediate life-threatening concern. The nurse must prioritize assessment findings that signal a risk of catastrophic hemorrhage or overwhelming infection.

Analysis of Assessment Findings

Thrombocytopenia is a near-universal consequence of both the leukemic infiltration of bone marrow and the myelosuppressive effects of chemotherapy agents, including the anthracyclines referenced in the provided pharmacovigilance data [1]. A platelet count of 15,000/μL represents severe thrombocytopenia. At this critically low level, the risk of spontaneous, life-threatening bleeding—including intracranial hemorrhage or massive gastrointestinal bleeding—is extremely high. The appearance of petechiae on the arms and legs is a clinical sign of this profound platelet deficit and microvascular fragility. This combination of a critical lab value and a physical sign of impaired hemostasis constitutes a medical emergency requiring immediate intervention, such as notification of the provider and preparation for platelet transfusion.

While the other options describe findings that warrant nursing attention, they do not pose the same immediate threat to life. Nausea and decreased appetite are common chemotherapy side effects manageable with antiemetics and nutritional support. The vital signs of temperature 99.2°F (37.3°C), BP 110/70 mmHg, and HR 88 bpm are within normal limits; notably, even a low-grade fever in a neutropenic patient would be more concerning than this normothermic reading. Restlessness and requests for position changes are consistent with the reported severe bone pain and require pain management but do not indicate an immediate, life-threatening deterioration.

Integration of Pharmacovigilance Data

The provided research underscores that anthracycline-based chemotherapy regimens, a cornerstone of AML treatment, are associated with a wide spectrum of serious adverse events [1]. The study’s analysis of the FDA Adverse Event Reporting System (FAERS) highlights that these agents carry distinct toxicity profiles. While the abstract specifically notes cardiotoxicity and pregnancy-related risks, the broader context of the study is the systematic identification of all significant side effects. Severe myelosuppression, resulting in critical thrombocytopenia as seen here, is one of the most immediately dangerous consequences of this drug class. The nurse’s clinical reasoning must connect the pharmacological action of the chemotherapy to the patient’s current presentation: the drug’s intended cytotoxic effect on leukemic cells also ablates normal megakaryocyte precursors, leading directly to the platelet count of 15,000/μL and the observed petechiae. This evidence reinforces why monitoring for hemorrhagic complications is the highest clinical priority in the post-chemotherapy period for acute leukemia patients [1].References (research sources)

- [1]Post-marketing safety evaluation of anthracycline for acute myeloid leukemia treatment: a real-world pharmacovigilance analysis.Research articleWang Y, Liu Q, Xu J, Yang F, Wang M, Lu H, Wu J, Zhang A, Zhang X, Wu D, Qiu H. (2026) · DOI: 10.3389/fphar.2026.1759201

## 임상 시나리오

Managing Severe Thrombocytopenia in LeukemiaRecognizing and Responding to Critical Hemorrhage Risk
A platelet count below 20,000/μL indicates severe thrombocytopenia with a risk of spontaneous, life-threatening bleeding, including intracranial hemorrhage. The presence of petechiae is a clinical sign of microvascular fragility.

Immediate nursing actions include notifying the provider, placing the patient on bleeding precautions, and preparing for a platelet transfusion as ordered. Avoid rectal temperatures, intramuscular injections, and use of aspirin or NSAIDs.

CautionSevere bone pain, while distressing, is an expected finding in acute leukemia and does not take priority over a critical lab value indicating imminent danger of catastrophic hemorrhage.

## 핵심 개념

- **Thrombocytopenia** — A condition characterized by abnormally low levels of platelets in the blood, increasing the risk of bleeding.
- **Petechiae** — Small, pinpoint, non-blanching red or purple spots on the skin caused by minor hemorrhage from broken capillary blood vessels.
- **Pancytopenia** — A deficiency of all three cellular components of the blood: red cells, white cells, and platelets.
- **Myelosuppression** — A condition in which bone marrow activity is decreased, resulting in fewer red blood cells, white blood cells, and platelets.

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