# A nurse is assessing a 45-year-old client who reports frequent infections over the past 6 months. Which assessment finding would be most indicative of compromised immune function?

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> subject: Adult Health

## 문제

A nurse is assessing a 45-year-old client who reports frequent infections over the past 6 months. Which assessment finding would be most indicative of compromised immune function?

## 보기

1. Elevated blood pressure of 150/90 mmHg
2. Complaint of joint stiffness in the morning
3. White blood cell count of 3,200/mm³ **✔ 정답**
4. Heart rate of 88 beats per minute

**정답: 3**

## 해설

A WBC count of 3,200/mm³ indicates leukopenia, directly reflecting compromised immune function and explaining frequent infections. Other findings (elevated BP, joint stiffness, normal heart rate) are not specific to immune dysfunction.

## 심화 해설

Correct Answer: 3

The correct answer is White blood cell count of 3,200/mm³. This value represents leukopenia, a direct laboratory indicator of a compromised immune system. The normal adult WBC count typically ranges from 4,000 to 11,000/mm³. A count of 3,200/mm³ falls below this threshold, signaling a quantitative deficit in the body's primary defense cells. For the NCLEX-RN, recognizing critical lab values that define immunosuppression is essential, as it directly impacts nursing interventions such as infection prevention protocols.

The other options are less specific for a primary immune dysfunction. An elevated blood pressure of 150/90 mmHg (option 1) is a cardiovascular concern but not a direct measure of immune cell quantity or function. Morning joint stiffness (option 2) is a classic symptom of inflammatory arthritides, like rheumatoid arthritis, which is an autoimmune process of immune dysregulation, not a failure of immune response leading to frequent infections. A heart rate of 88 beats per minute (option 4) is within the normal adult range and is a non-specific finding that would not be the primary indicator for compromised immunity in this clinical scenario.

Deep Dive: Linking Leukopenia to Immune Dysfunction

The connection between a low WBC count and frequent infections is rooted in the fundamental role of leukocytes in hematopoiesis and immune surveillance. The provided evidence on GATA2 deficiency offers a powerful clinical model for understanding this link. The GATA2 gene encodes a critical zinc finger transcription factor that plays an indispensable role in hematopoiesis and immune regulation [1]. A pathogenic variant in this gene disrupts the production and development of multiple blood cell lineages, including white blood cells, directly causing a profound immune dysfunction [1]. This genetic defect manifests clinically as a syndrome that includes severe infections, myelodysplasia, and leukemia, all stemming from a bone marrow failure to produce a functional immune system [1].

For the NCLEX-RN examinee, this case illustrates a core principle: a quantitative deficiency in WBCs, regardless of the underlying cause (genetic, drug-induced, or infectious), directly impairs the body's ability to fight pathogens. The assessment finding of a WBC count of 3,200/mm³ is the most direct and objective data point that explains the client's six-month history of frequent infections. In clinical practice, this finding would immediately trigger a nursing care plan focused on neutropenic precautions, including strict hand hygiene, avoidance of individuals with active infections, and meticulous monitoring for subtle signs of infection, as the typical inflammatory response of redness, pus, or swelling may be absent [1].References (research sources)

- [1]GATA2 Deficiency Syndrome: A Case Series and Literature Review.Case reportDong Z, Lai J, Li J, Du Y, Lin L, Chen R, Gong M, Zhuansun Y. (2026) · DOI: 10.1007/s10875-026-02013-1

## 임상 시나리오

Interpreting LeukopeniaClinical Guide for the Immunocompromised Patient
A white blood cell (WBC) count below 4,000/mm³ defines leukopenia. A value of 3,200/mm³ is a direct, quantitative marker of compromised immune function and correlates strongly with a history of frequent infections.

When leukopenia is identified, the priority nursing action is to initiate neutropenic precautions to protect the patient from environmental pathogens. This includes strict hand hygiene, avoiding fresh flowers or raw foods, and immediate reporting of any signs of infection.

CautionDo not rely on vital signs like heart rate or blood pressure to rule out immune compromise. A normal heart rate of 88 bpm or isolated hypertension are non-specific and do not reflect the body's cellular defense capacity.

## 핵심 개념

- **Leukopenia** — A total white blood cell count below the normal reference range, typically less than 4,000/mm³, indicating a quantitative immune deficit.
- **Normal WBC Count** — The standard adult reference range for white blood cells is 4,000 to 11,000/mm³.
- **Immunocompromised** — A state of impaired immune response, which can be caused by quantitative defects like leukopenia, increasing susceptibility to frequent infections.

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