# A 7-year-old child with acute lymphoblastic leukemia (ALL) is receiving chemotherapy and has developed severe neutropenia with an absolute neutrophil count (ANC) of 200 cells/mm³. The child develops a fever of 101.5°F (38.6°C). What is the most appropriate immediate nursing intervention? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=542188 > language: ko > subject: Adult Health ## 문제 A 7-year-old child with acute lymphoblastic leukemia (ALL) is receiving chemotherapy and has developed severe neutropenia with an absolute neutrophil count (ANC) of 200 cells/mm³. The child develops a fever of 101.5°F (38.6°C). What is the most appropriate immediate nursing intervention? ## 보기 1. Administer acetaminophen and monitor temperature every 4 hours 2. Obtain blood cultures and wait for physician orders before further action 3. Place the child in protective isolation and restrict all visitors 4. Immediately notify the physician and prepare for emergency antibiotic administration **✔ 정답** **정답: 4** ## 해설 Febrile neutropenia in pediatric oncology patients is a medical emergency requiring immediate antibiotic administration to prevent sepsis. Other options delay critical treatment. ## 심화 해설 Understanding the Clinical Scenario The child in this question is experiencing febrile neutropenia (FN), a critical oncologic emergency. With an absolute neutrophil count (ANC) of 200 cells/mm³, the child is severely neutropenic and has lost the primary cellular defense against bacterial and fungal pathogens. In this immunocompromised state, a fever of 101.5°F (38.6°C) is not a routine symptom; it is a medical emergency that signals a potentially life-threatening infection. The absence of neutrophils means the body cannot mount a typical inflammatory response, so a fever may be the only initial sign of a rapidly progressing bloodstream infection (BSI). Why Immediate Antibiotic Administration is the Priority The most appropriate immediate nursing intervention is to notify the physician and prepare for emergency antibiotic administration. The rationale is rooted in the time-sensitive nature of FN management. A foundational study on pediatric FN treatment demonstrated that adapting standard operating procedures to reduce the time-to-antibiotic (TTA) is a critical step in improving patient prognosis [1]. Any delay in administering empiric broad-spectrum antibiotics directly correlates with increased morbidity and mortality from sepsis. The nurse’s role is to recognize that the physician’s order for antibiotics is a predictable, protocol-driven response, and the nurse must proactively prepare for administration by ensuring IV access, obtaining the correct weight-based medication, and having emergency equipment ready. Waiting for a physician order without simultaneous preparation introduces a clinically significant and dangerous delay. Analyzing the Incorrect Options - **Option 1 (Administer acetaminophen and monitor):** This is dangerous in a neutropenic patient. Administering an antipyretic masks the fever, which is a critical diagnostic clue and a key indicator of the patient’s response to antimicrobial therapy. Routine temperature monitoring is part of care, but it is never the priority intervention over initiating definitive treatment for the suspected infection. - **Option 2 (Obtain blood cultures and wait):** Obtaining blood cultures is a necessary step in the diagnostic workup for FN, as it helps identify the causative organism, which is often a Gram-negative or Gram-positive bacteria . However, this action must not delay the administration of antibiotics. The cultures should be drawn urgently, and the antibiotics should be started immediately afterward, without waiting for the physician to review the results or give a separate order if a standing FN protocol exists. The phrase "wait for physician orders before further action" makes this option incorrect because it promotes a passive and delayed response. - **Option 3 (Place in protective isolation and restrict visitors):** Protective isolation is an important infection prevention measure for severely neutropenic patients to protect them from external pathogens. However, in the context of an active fever, the immediate threat is an endogenous or already-acquired infection that has now disseminated. Addressing the suspected infection with antibiotics takes absolute priority over environmental controls. The child’s own microbial flora is the most likely source of infection at this moment. Connecting Clinical Signs to the Underlying Risk The urgency of this scenario is underscored by the high risk of bloodstream infection in this population. Research indicates that a significant proportion of pediatric FN cases, around 30.2% in one prospective study, are complicated by confirmed bloodstream infections . Furthermore, a fever in a child with leukemia can present a diagnostic dilemma, as it may arise from the infection itself or from a blood product transfusion. A clinical prediction model has been developed to help distinguish a post-transfusion febrile reaction from an early BSI at the bedside, highlighting the diagnostic challenge and the principle that infection must be assumed until proven otherwise . Even dynamic changes in hematologic parameters are being studied to create models that predict short-term clinical deterioration within 7 days in children with ALL, reinforcing that clinical events can evolve rapidly and require a proactive, rather than reactive, management strategy . The nurse’s immediate action of preparing for emergency antibiotics directly confronts the most likely and most lethal threat: an overwhelming bacterial infection in a host with no neutrophil defense.References (research sources) - [1]Reducing the Time-to-Antibiotic by Adapting a Standard of Procedure for the Treatment of Pediatric Cancer Patients Presenting with Febrile Neutropenia-A Comparative Analysis of Two Patient Cohorts.Research articleMalvestiti S, Strahm B, Flotho C, Hufnagel M, Feuchtinger T, Puzik A. (2025) · DOI: 10.3390/cancers17203280 ## 임상 시나리오 Febrile Neutropenia ManagementImmediate Action for the Immunocompromised Child In a child with an absolute neutrophil count (ANC) of 200 cells/mm³, a fever of 38.6°C (101.5°F) is an oncologic emergency. The absence of neutrophils prevents a typical inflammatory response, making fever the only early sign of a life-threatening bloodstream infection. The priority intervention is to immediately notify the physician and prepare for emergency antibiotic administration. The goal time-to-antibiotic (TTA) is under 60 minutes from the time of fever documentation to infusion start. CautionDo not delay antibiotic therapy to wait for blood culture results or physician orders. Obtain cultures promptly, but administer empiric broad-spectrum antibiotics immediately per protocol to prevent progression to septic shock. ## 핵심 개념 - **Febrile Neutropenia** — A medical emergency defined as an ANC - **Absolute Neutrophil Count (ANC)** — A measure of the body's ability to fight bacterial infections; severe neutropenia is defined as an ANC - **Time-to-Antibiotic (TTA)** — The critical interval from fever onset to antibiotic infusion, with a goal of less than 60 minutes to reduce sepsis-related mortality. - **Empiric Broad-Spectrum Antibiotics** — Anti-infective agents initiated before the specific pathogen is identified, covering a wide range of likely gram-positive and gram-negative bacteria. - **Oncologic Emergency** — An acute, potentially life-threatening condition caused by cancer or its treatment, requiring immediate medical intervention. ## 같은 주제 문제 - [A nurse is assessing a 28-year-old patient with acute lymphoblastic leukemia (ALL) who was…](https://mymerci.kr/pages/nclex_q.php?qn_id=540669) - [The nurse is conducting a comprehensive assessment of a 70-year-old patient with AML who h…](https://mymerci.kr/pages/nclex_q.php?qn_id=540670) - [A nurse is caring for a client with acute lymphoblastic leukemia (ALL) who has been receiv…](https://mymerci.kr/pages/nclex_q.php?qn_id=540671) - [A nurse is assessing a 65-year-old patient newly diagnosed with acute lymphoblastic leukem…](https://mymerci.kr/pages/nclex_q.php?qn_id=540672) - [A nurse is caring for a 12-year-old child with acute lymphoblastic leukemia (ALL) who has …](https://mymerci.kr/pages/nclex_q.php?qn_id=540673) - [A nurse is caring for a patient with acute lymphoblastic leukemia (ALL) who has just compl…](https://mymerci.kr/pages/nclex_q.php?qn_id=540674) - [A nurse is caring for a client with acute myeloid leukemia (AML) who has developed tumor l…](https://mymerci.kr/pages/nclex_q.php?qn_id=540675) - [The nurse is monitoring a client with acute lymphoblastic leukemia during chemotherapy tre…](https://mymerci.kr/pages/nclex_q.php?qn_id=540676) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._