# A nurse is caring for a client with stage IV small cell lung cancer who is receiving chemotherapy and has fatigue, shortness of breath, and a white blood cell count of 2,000/mm³. Which nursing intervention should be the priority to prevent the most life-threatening complication?

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> subject: Adult Health

## 문제

A nurse is caring for a client with stage IV small cell lung cancer who is receiving chemotherapy and has fatigue, shortness of breath, and a white blood cell count of 2,000/mm³. Which nursing intervention should be the priority to prevent the most life-threatening complication?

The client is experiencing fatigue, shortness of breath, and has a white blood cell count of 2,000/mm³.

## 보기

1. Encourage increased fluid intake to prevent dehydration
2. Provide emotional support and counseling resources
3. Implement strict infection control precautions and monitor for signs of infection **✔ 정답**
4. Administer prescribed antiemetics to prevent nausea and vomiting

**정답: 3**

## 해설

Implementing strict infection control is the priority due to neutropenia (WBC 2,000/mm³), which poses a high risk for life-threatening infection. Other interventions are important but address less immediate threats.

## 심화 해설

Understanding the Priority: Life-Threatening Complication in Neutropenia

For a client with stage IV small cell lung cancer undergoing chemotherapy, the reported white blood cell (WBC) count of 2,000/mm³ indicates severe immunosuppression. While the absolute neutrophil count (ANC) is the most specific marker, a WBC this low strongly correlates with profound neutropenia (typically defined as an ANC

## 임상 시나리오

Neutropenic PrecautionsPreventing Sepsis in Immunosuppressed Clients
A WBC count of 2,000/mm³ indicates severe immunosuppression. The priority is strict infection control to prevent sepsis, the most life-threatening complication.

Implement protective isolation with strict hand hygiene. Monitor for subtle signs of infection, as the typical inflammatory response (redness, pus) may be absent. A fever of 38.0°C (100.4°F) or higher is a medical emergency.

CautionAvoid rectal temperatures, suppositories, and enemas to prevent mucosal tears. No fresh flowers or raw foods. Immediate antibiotic administration is critical once cultures are drawn.

## 핵심 개념

- **Neutropenia** — An abnormally low count of neutrophils, a type of white blood cell that helps fight infection, often a side effect of chemotherapy.
- **Immunosuppression** — Reduction in the activation or efficacy of the immune system, increasing susceptibility to opportunistic infections.
- **Absolute Neutrophil Count (ANC)** — A calculation of the actual number of neutrophils in a blood sample, used to assess infection risk; severe neutropenia is typically ANC < 500/mm³.
- **Small Cell Lung Cancer** — An aggressive form of lung cancer strongly associated with smoking, often treated with chemotherapy due to its rapid growth and early metastasis.

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