Nclexrn Quiz: Protective Isolation And Neutropenia Precautions
20 questions · exam conditions
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Protective Isolation And Neutropenia PrecautionsQuestion 1 of 20

A 64-year-old client with chronic lymphocytic leukemia is hospitalized for neutropenic precautions after chemotherapy. Labs show ANC 450/mm³; the client has mild gingival bleeding and oral mucositis but no fever. The nurse should QUESTION which order related to infection control?

Obtain rectal temperatures every 4 hours to monitor for fever
Encourage frequent oral care and use a soft toothbrush
Avoid fresh flowers and standing water in the room
Use meticulous hand hygiene before and after all client contact
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Nclexrn Quiz: Protective Isolation And Neutropenia Precautions

Practice Protective Isolation And Neutropenia Precautions in Nclexrn with focused quiz questions that help you check what you know, review explanations, and build confidence with test-style prompts.

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Question 1

A 64-year-old client with chronic lymphocytic leukemia is hospitalized for neutropenic precautions after chemotherapy. Labs show ANC 450/mm³; the client has mild gingival bleeding and oral mucositis but no fever. The nurse should QUESTION which order related to infection control?

  1. Obtain rectal temperatures every 4 hours to monitor for fever (correct answer)
  2. Encourage frequent oral care and use a soft toothbrush
  3. Avoid fresh flowers and standing water in the room
  4. Use meticulous hand hygiene before and after all client contact
Explanation: This question tests infection control and preventive care for neutropenic clients. The priority concern is identifying contraindicated procedures that could introduce infection in a neutropenic patient with mucositis. Obtaining rectal temperatures (A) should be questioned because rectal manipulation is contraindicated in neutropenic patients due to risk of introducing bacteria through compromised mucosa and causing bacteremia. Oral care with soft toothbrush (B), avoiding flowers (C), and meticulous hand hygiene (D) are all appropriate neutropenic precautions. The principle of neutropenic precautions is to avoid any invasive procedures that could breach mucosal barriers and introduce infection. A transferable strategy is to remember "no rectal anything" in neutropenic patients - no rectal temperatures, suppositories, or exams.

Question 2

A 62-year-old client with metastatic prostate cancer is hospitalized with ANC 700/mm³. The client asks about shaving while neutropenic because of "small cuts." Which teaching should the nurse provide to reduce infection risk?

  1. Use an electric razor to reduce skin breaks that can become portals of entry for infection (correct answer)
  2. Use a straight razor for the closest shave and apply aftershave to disinfect
  3. Avoid bathing for several days after shaving to keep skin oils intact
  4. Apply antibiotic ointment daily to the entire shaved area even if there are no cuts
Explanation: This question tests infection control and preventive care for neutropenic clients. The priority concern is preventing infection in immunocompromised clients by reducing skin integrity breaches. Teaching to use an electric razor is the most effective because it minimizes cuts that serve as infection entry points. Straight razors increase nicks; avoiding bathing promotes infection; routine antibiotics are unnecessary. Neutropenic precautions promote safe personal care to preserve skin barriers. These include choosing tools that prevent trauma. A transferable strategy for infection prevention in immunosuppressed clients is to recommend injury-preventing alternatives in daily routines.

Question 3

A 36-year-old client is 12 days post–bone marrow transplant for aplastic anemia and is hospitalized. Labs show ANC 150/mm³. The client's partner arrives with a bouquet of fresh flowers and asks to place them in the room. What is the PRIORITY nursing action to prevent infection?

  1. Allow the flowers if they are kept at least 6 feet from the client's bed
  2. Ask the partner to take the flowers home and perform hand hygiene before visiting (correct answer)
  3. Place the flowers in a sealed plastic bag and store them in the room's bathroom
  4. Request an order for prophylactic antifungal therapy due to the flowers
Explanation: This question tests infection control and preventive care for neutropenic clients. The priority concern is preventing infection in immunocompromised clients post-bone marrow transplant by eliminating environmental pathogen sources like mold in flowers. Asking the partner to take the flowers home and perform hand hygiene is the most effective action because it removes a potential fungal reservoir while ensuring visitor hygiene. Allowing flowers at a distance still risks airborne spores; sealing in a bag is inadequate; prophylactic antifungals are not indicated solely for flowers. Neutropenic precautions prohibit fresh flowers and plants to avoid aspergillosis and bacterial infections. These include environmental controls to maintain a clean, low-microbe setting. A transferable strategy for infection prevention in immunosuppressed clients is to assess and eliminate everyday items that could harbor pathogens in care environments.

Question 4

A 59-year-old client with leukemia is hospitalized and neutropenic (ANC 290/mm³). The client is scheduled for a rectal temperature check due to low-grade fever. The nurse should QUESTION which order related to infection control?

  1. Obtain oral temperature instead of rectal temperature
  2. Avoid rectal suppositories and rectal examinations when possible
  3. Perform perineal care after each bowel movement using gentle technique
  4. Check rectal temperature every 4 hours for the most accurate measurement (correct answer)
Explanation: This question tests infection control and preventive care for neutropenic clients. The priority concern is preventing infection in immunocompromised clients by avoiding procedures that risk mucosal injury. Checking rectal temperature every 4 hours should be questioned because it can cause perforation and bacteremia in neutropenia. Obtaining oral temperatures is safer; avoiding suppositories prevents trauma; perineal care reduces contamination. Neutropenic precautions prohibit rectal interventions to protect fragile tissues. These include using alternative methods for vital signs monitoring. A transferable strategy for infection prevention in immunosuppressed clients is to challenge invasive orders that could introduce pathogens.

Question 5

A 57-year-old client with leukemia is hospitalized with ANC 480/mm³. The client has a temperature of 38.2°C (100.8°F) and is scheduled for routine dental cleaning today. Which nursing action is most appropriate?

  1. Proceed with dental cleaning while applying oral care protocols, because oral hygiene reduces infection risk.
  2. Hold the dental appointment and notify the provider due to fever and neutropenia. (correct answer)
  3. Give ibuprofen before the appointment to reduce inflammation and allow the dental cleaning to be completed.
  4. Switch to contact precautions for the dental appointment and require staff to wear gloves and masks.
Explanation: Neutropenia with fever means the client has little reserve against infection. Dental cleaning can traumatize oral tissues and cause bacteremia, so this elective procedure should be postponed and the provider notified. Continuing with the dental cleaning, even while applying oral care protocols, leaves the client exposed to an avoidable infection risk. Giving ibuprofen before the appointment may lower fever and inflammation but does not correct neutropenia or make the procedure safe; it can also mask important findings. Switching to contact precautions is not an appropriate protective strategy for neutropenia; contact precautions are used for contact-transmissible organisms, and they do not address the need to postpone the procedure. The safest nursing action is to hold the dental appointment and notify the provider so the fever can be evaluated and the dental cleaning can be rescheduled when the client is more protected.

Question 6

A 44-year-old client with breast cancer is receiving outpatient chemotherapy and is being discharged home. Today's lab work shows ANC 780/mm³ (neutropenia). The client reports a sore throat and new fatigue but is afebrile. Which client education point should the nurse emphasize to reduce infection risk at home?

  1. Use a soft toothbrush and avoid flossing to prevent gum bleeding
  2. Avoid crowds and people who are sick, and take your temperature daily (correct answer)
  3. Wear a gown and gloves when using the bathroom at home
  4. Receive all live vaccines to boost immunity during chemotherapy
Explanation: This question tests infection control and preventive care for neutropenic clients. The priority concern is preventing infection in immunocompromised clients during outpatient chemotherapy by educating on self-monitoring and avoidance behaviors. Avoiding crowds and sick people while taking daily temperatures is the most effective education point because it empowers the client to detect and avoid infection sources early. Using a soft toothbrush is more relevant for thrombocytopenia; wearing gown and gloves at home is unnecessary and impractical; receiving live vaccines is contraindicated in immunocompromised states. Neutropenic precautions emphasize monitoring for fever and avoiding high-risk exposures like crowds. These include dietary restrictions and hygiene to maintain a low-microbial environment. A transferable strategy for infection prevention in immunosuppressed clients is to teach self-assessment and prompt reporting of symptoms to facilitate early intervention.

Question 7

A 63-year-old client with acute lymphoblastic leukemia is hospitalized with ANC 240/mm³. The client has a central venous catheter and reports tenderness at the insertion site; temperature is 38.2°C (100.8°F). What is the PRIORITY action to reduce infection risk?

  1. Place the client in a shared room with another neutropenic client to reduce staffing exposure
  2. Administer acetaminophen to reduce the fever
  3. Encourage the client to ambulate in the hallway to prevent deconditioning
  4. Assess the catheter site and perform sterile dressing change per protocol (correct answer)
Explanation: This question tests infection control and preventive care for neutropenic clients. The priority concern is preventing infection in immunocompromised clients with central lines and signs of site infection like tenderness and fever. Assessing the catheter site and performing a sterile dressing change is the most effective action because it addresses potential line sepsis promptly. Administering acetaminophen masks symptoms; encouraging ambulation increases exposure; shared rooms heighten infection risk. Neutropenic precautions emphasize aseptic central line care to prevent bloodstream infections. These include regular site inspections and sterile techniques. A transferable strategy for infection prevention in immunosuppressed clients is to prioritize vascular access device management to avoid catheter-related infections.

Question 8

A 73-year-old client with bladder cancer is hospitalized after chemotherapy with ANC 590/mm³. The client has cloudy urine and reports urinary frequency; temperature is 38.0°C (100.4°F). What is the PRIORITY nursing action?

  1. Encourage cranberry juice intake to acidify the urine
  2. Notify the provider and anticipate obtaining urine and blood cultures using aseptic technique (correct answer)
  3. Apply a heating pad to the suprapubic area for comfort
  4. Teach the client to complete antibiotics if prescribed after discharge
Explanation: This question tests infection control and preventive care for neutropenic clients. The priority concern is preventing infection in immunocompromised clients with urinary symptoms and fever suggesting UTI or sepsis. Notifying the provider and anticipating cultures is the most effective action because it enables timely diagnosis and treatment. Cranberry juice is unproven; heating pads don't address infection; teaching post-discharge is secondary. Neutropenic precautions require urgent workup for infection signs. These include aseptic collection for accurate cultures. A transferable strategy for infection prevention in immunosuppressed clients is to initiate diagnostic protocols swiftly for site-specific symptoms.

Question 9

A 67-year-old client with non-Hodgkin lymphoma is hospitalized 7 days after chemotherapy. Labs: white blood cell count 1.1 × 10^3/µL, ANC 410/mm³. The client has mouth ulcers and reports burning with urination. Which is the PRIORITY action to reduce infection risk?

  1. Encourage the client to increase oral fluid intake to 3 liters/day
  2. Ensure dedicated equipment is used and perform meticulous hand hygiene for all care (correct answer)
  3. Place the client in a negative-pressure room to prevent airborne transmission
  4. Obtain a provider order for a urinary catheter to monitor output accurately
Explanation: This question tests infection control and preventive care for neutropenic clients. The priority concern is preventing infection in immunocompromised clients with symptoms like mouth ulcers and dysuria that could indicate or lead to infection. Ensuring dedicated equipment and meticulous hand hygiene is the most effective action because it reduces cross-contamination and pathogen introduction during care. Encouraging fluid intake is beneficial but not the priority over hygiene; negative-pressure rooms are for airborne pathogens, not neutropenia; inserting a catheter increases infection risk in neutropenic clients. Neutropenic precautions involve using dedicated items and strict asepsis to protect vulnerable mucosal barriers. These include avoiding invasive procedures unless necessary to prevent bacterial entry. A transferable strategy for infection prevention in immunosuppressed clients is to implement barrier nursing techniques and hygiene protocols to minimize nosocomial infections.

Question 10

A 51-year-old client with lymphoma is hospitalized with ANC 350/mm³ and has a temperature of 38.4°C (101.1°F). A family member brings homemade soup in a reusable container. Which nursing action is most appropriate to reduce infection risk?

  1. Allow the soup if it is heated until steaming hot before the client eats it (correct answer)
  2. Allow the soup only if the family member eats some first to show it is safe
  3. Discard the soup because all outside food is prohibited for neutropenic clients
  4. Store the soup at room temperature for 4 hours to cool and then serve it
Explanation: This question tests infection control and preventive care for neutropenic clients. The priority concern is preventing infection in immunocompromised clients from potentially contaminated outside food. Allowing the soup if heated until steaming hot is the most appropriate action because high heat kills bacteria, aligning with low-microbial diet principles. Having family eat it doesn't ensure safety; discarding all outside food is overly restrictive; storing at room temperature promotes growth. Neutropenic precautions allow reheated home foods if handled safely. These include ensuring hot foods are served hot to reduce pathogens. A transferable strategy for infection prevention in immunosuppressed clients is to apply food safety techniques like proper reheating in dietary management.

Question 11

A 55-year-old client with ovarian cancer is hospitalized with neutropenia (ANC 390/mm³). The client is alert, reports no pain, and has a temperature of 37.4°C (99.3°F). The client's family asks what they can bring to help. Which client education point should the nurse emphasize?

  1. Family members should bring fresh-cut flowers and a small cool-mist humidifier; these can keep the room comfortable and pleasant for the client.
  2. Visitors who are sick or recently exposed to illness should not visit; perform hand hygiene on entry and exit. (correct answer)
  3. The client should avoid wearing a mask when leaving the room to prevent skin irritation and keep breathing comfortable.
  4. Family members should wear sterile gloves while sitting at the bedside even if they do not plan to touch the client.
Explanation: An ANC of 390/mm³ means this client is severely neutropenic, so the nurse's priority is to prevent exposure to new organisms. The correct teaching is to keep sick or recently exposed visitors away and to perform hand hygiene on entry to and exit from the room. That is the core of protective isolation and directly lowers infection risk. Fresh-cut flowers and a cool-mist humidifier are not appropriate: flowers and standing water can harbor mold and bacteria, and a humidifier can aerosolize organisms, so these increase infection risk. Telling the client to avoid a mask when leaving the room is unsafe because a mask is recommended when a neutropenic client leaves a protected environment; skin irritation should be managed with a different mask or skin care, not by skipping protection. Sterile gloves while sitting at the bedside are unnecessary and are not a substitute for hand hygiene; gloves are indicated for contact with body fluids or certain procedures, not for family members who are only sitting. Therefore, the nurse should emphasize visitor screening and hand hygiene.

Question 12

A 47-year-old client with lymphoma is hospitalized post-chemotherapy with ANC 600/mm³. The client has painful oral mucositis and minor gum bleeding. Which client education point should the nurse emphasize to reduce infection risk?

  1. Take leftover antibiotics from a previous illness at home if mouth pain or bleeding worsens
  2. Use an oral irrigator (water flosser) daily to remove plaque aggressively from around the gums
  3. Avoid bathing and skin care routines to prevent dryness and cracking of fragile skin
  4. Perform oral care frequently with a soft toothbrush and nonalcohol mouth rinse (correct answer)
Explanation: The priority for a neutropenic client with oral mucositis and gum bleeding is to protect mucosal and skin barriers so bacteria cannot enter. Frequent gentle oral care with a soft toothbrush and a nonalcohol rinse cleans the mouth without abrading fragile tissues; alcohol-based rinses and stiff brushes can increase breakdown and bleeding, creating portals for infection. The other options are unsafe or counterproductive. Taking leftover antibiotics from a previous illness is not a current prescription and can promote resistance, mask a developing infection, and delay needed evaluation. Using an oral irrigator daily and aggressively can traumatize friable oral mucosa and push bacteria into the bloodstream. Avoiding bathing allows skin flora to accumulate and raises infection risk; gentle daily cleansing with mild products is needed. Therefore, the nurse should emphasize frequent, gentle oral care with a soft toothbrush and nonalcohol rinse.

Question 13

A 41-year-old client is day 12 post–bone marrow transplant for aplastic anemia and is hospitalized on a protective environment unit. Labs show ANC 180/mm³ and white blood cell count 0.4 × 10^3/µL; the client has mouth sores but is afebrile. Which precaution should the nurse implement FIRST for this client?

  1. Use dedicated equipment for the client and disinfect shared surfaces frequently
  2. Ensure all staff and visitors perform strict hand hygiene and screen visitors for illness before entry (correct answer)
  3. Place the client on contact precautions with gown and gloves for all room entry
  4. Request a provider order for antifungal prophylaxis due to severe neutropenia
Explanation: This question tests infection control and preventive care for neutropenic clients. The priority concern is maintaining a protective environment for a profoundly neutropenic post-transplant patient at extreme risk for infection. Ensuring strict hand hygiene and visitor screening (B) is the most fundamental and effective first action to prevent pathogen transmission to this severely immunocompromised patient. While dedicated equipment (A) and antifungal prophylaxis (D) are important, they follow basic infection control; contact precautions (C) are not indicated for neutropenia alone. The principle of neutropenic precautions in profound neutropenia (ANC <200/mm³) is that hand hygiene and limiting exposure to ill contacts are the cornerstone of infection prevention. A transferable strategy is to prioritize the basics first - hand hygiene is the single most effective infection prevention measure.

Question 14

A 33-year-old client with breast cancer is in an outpatient oncology clinic for scheduled chemotherapy. Today's labs show ANC 640/mm³ and white blood cell count 1.6 × 10^3/µL; the client reports mild fatigue but denies fever. The nurse is providing discharge teaching for home neutropenia precautions. Which client education point should the nurse emphasize?

  1. Take your temperature daily and call the oncology team immediately for a temperature of 38.0°C (100.4°F) or higher (correct answer)
  2. Wear an N95 respirator in public places until your white blood cell count returns to normal
  3. Stop all fresh fruits and vegetables permanently to prevent infection
  4. Receive all live vaccines this week to prevent viral infections
Explanation: This question tests infection control and preventive care for neutropenic clients. The priority concern is teaching the client to recognize and respond to neutropenic fever, which is a medical emergency requiring immediate intervention. Teaching daily temperature monitoring and immediate reporting of fever ≥38.0°C (A) is the most critical education point because early detection and treatment of neutropenic fever can be lifesaving. Wearing an N95 respirator (B) is excessive for routine community exposure; permanently stopping fresh produce (C) is unnecessarily restrictive; and live vaccines (D) are contraindicated in immunosuppressed patients. The principle of neutropenic precautions at home is empowering patients to monitor for and immediately report signs of infection, especially fever. A transferable strategy is to teach the "100.4°F rule" - any temperature at or above this threshold requires immediate medical attention for neutropenic patients.

Question 15

A 46-year-old client with non-Hodgkin lymphoma is hospitalized 7 days after chemotherapy. Assessment shows ANC 480/mm³, white blood cell count 1.1 × 10^3/µL, and a new sore throat; temperature is 37.9°C (100.2°F). What is the PRIORITY action to reduce infection risk?

  1. Provide a surgical mask for the client to wear whenever leaving the room for tests
  2. Assign the client to a private room and screen visitors for illness before allowing entry (correct answer)
  3. Apply alcohol-based hand rub and then don sterile gloves for all care tasks
  4. Request a provider order to start prophylactic intravenous antibiotics now
Explanation: This question tests infection control and preventive care for neutropenic clients. The priority concern is preventing infection transmission to an immunocompromised client with moderate neutropenia who is showing early signs of infection. Assigning a private room and screening visitors (B) is the most effective immediate action to minimize exposure to pathogens from other patients and potentially infectious visitors. Providing a mask for the client (A) protects others from the client but doesn't protect the neutropenic client; sterile gloves (C) are unnecessary for routine care; and prophylactic antibiotics (D) are not indicated without fever or confirmed infection. The principle of neutropenic precautions is to create a protective environment by limiting exposure to potential pathogens through private rooms, visitor screening, and meticulous hand hygiene. A transferable strategy is to focus on environmental controls and limiting exposures as the first-line defense for neutropenic patients.

Question 16

A 55-year-old client with multiple myeloma is hospitalized after chemotherapy. Labs: ANC 680/mm³. The client's child wants to visit and reports having a runny nose and cough. Which precaution should the nurse implement FIRST?

  1. Allow the visit if the child wears a surgical mask at all times
  2. Ask the child to postpone the visit until symptoms have resolved (correct answer)
  3. Initiate contact precautions and require gown and gloves for the child
  4. Teach the client to avoid public swimming pools after discharge
Explanation: This question tests infection control and preventive care for neutropenic clients. The priority concern is preventing infection in immunocompromised clients by screening visitors for illness. Asking the child to postpone the visit until symptoms resolve is the most effective first action because it avoids exposing the client to respiratory pathogens. Allowing with a mask is insufficient for symptomatic visitors; contact precautions are not indicated; teaching about pools is unrelated to the immediate issue. Neutropenic precautions restrict ill visitors to protect against viral and bacterial transmission. These include family education on infection risks during visits. A transferable strategy for infection prevention in immunosuppressed clients is to implement visitor restrictions based on symptom screening.

Question 17

A 39-year-old client with leukemia is hospitalized post-chemotherapy with ANC 260/mm³. The client has a temperature of 38.6°C (101.5°F) and blood pressure 92/54 mm Hg. What is the PRIORITY nursing action?

  1. Administer prescribed broad-spectrum intravenous antibiotics after obtaining ordered cultures (correct answer)
  2. Provide teaching on avoiding raw foods and using a soft toothbrush
  3. Place the client on contact precautions due to hypotension
  4. Schedule the client for a shower to decrease skin bacteria
Explanation: This question tests infection control and preventive care for neutropenic clients. The priority concern is recognizing signs of infection, such as fever and hypotension, in an immunocompromised client with a low absolute neutrophil count (ANC), which increases the risk of sepsis. The correct answer, administering prescribed broad-spectrum intravenous antibiotics after obtaining ordered cultures, is the most effective action because it addresses the urgent need to treat potential bacterial infection promptly in neutropenic fever to prevent rapid deterioration. The distractors are less optimal: providing teaching (B) is important for long-term prevention but not immediate; placing on contact precautions due to hypotension (C) is incorrect as contact precautions protect others from infectious clients, not the reverse, and hypotension isn't the basis; scheduling a shower (D) may reduce bacteria but doesn't address the acute infection risk. Neutropenic precautions involve protective measures like hand hygiene, avoiding crowds, and monitoring for infection signs to safeguard the client from pathogens. These precautions also include dietary restrictions and gentle oral care to minimize infection entry points. A transferable strategy for infection prevention in immunosuppressed clients is to prioritize early recognition of fever as a medical emergency and initiate empiric antibiotics swiftly while investigating the source.

Question 18

A 29-year-old client with testicular cancer is receiving chemotherapy in an outpatient infusion center. Today the ANC is 900/mm³ and the client reports a new burning sensation with urination since yesterday; temperature is 37.8°C (100.0°F). Which precaution should the nurse implement FIRST for this client?

  1. Proceed with chemotherapy and reinforce that mild urinary symptoms are expected
  2. Hold the chemotherapy and notify the oncology provider about possible infection in a neutropenic client (correct answer)
  3. Place the client on airborne precautions until urinary infection is ruled out
  4. Teach the client to increase dietary fiber to prevent constipation during treatment
Explanation: This question tests infection control and preventive care for neutropenic clients. The priority concern is recognizing potential urinary tract infection in a mildly neutropenic patient before administering immunosuppressive chemotherapy. Holding chemotherapy and notifying the provider (B) is the most appropriate first action because administering chemotherapy could worsen neutropenia and complicate a developing infection. Proceeding with chemotherapy (A) risks severe complications; airborne precautions (C) are not indicated for UTI; dietary teaching (D) is unrelated to the immediate concern. The principle of neutropenic precautions is to identify and treat infections before further immunosuppression. A transferable strategy is to assess for any signs of infection before chemotherapy administration, as even mild symptoms warrant investigation in neutropenic patients.

Question 19

A 48-year-old client with colorectal cancer is hospitalized 8 days after chemotherapy. The client's ANC is 260/mm³; vital signs are temperature 38.0°C (100.4°F), heart rate 112/min, blood pressure 98/60 mm Hg, and the client reports feeling weak. What is the PRIORITY action to reduce infection risk?

  1. Administer acetaminophen as needed for fever and reassess in 1 hour
  2. Notify the provider/rapid response per facility protocol and prepare for immediate sepsis workup and prompt antibiotic therapy (correct answer)
  3. Initiate contact precautions with gown and gloves for all room entry
  4. Teach the client to avoid crowds and to wash hands frequently after discharge
Explanation: This question tests infection control and preventive care for neutropenic clients. The priority concern is recognizing neutropenic sepsis with hemodynamic instability requiring immediate intervention. Notifying the provider/rapid response and initiating sepsis protocol (B) is the most critical action because the patient shows signs of septic shock (fever, tachycardia, hypotension) with severe neutropenia, requiring immediate resuscitation and antibiotics. Administering acetaminophen alone (A) dangerously delays treatment; contact precautions (C) don't address the emergency; discharge teaching (D) is inappropriate for an unstable patient. The principle of neutropenic precautions is that neutropenic fever with vital sign instability is a life-threatening emergency requiring immediate sepsis protocol activation. A transferable strategy is to recognize the triad of neutropenia + fever + abnormal vitals as neutropenic sepsis requiring immediate escalation of care.

Question 20

A 58-year-old client with acute myeloid leukemia is hospitalized on day 9 after induction chemotherapy. Current labs show absolute neutrophil count (ANC) 320/mm³ (severe neutropenia) and white blood cell count 0.7 × 10^3/µL; the client reports chills and has an oral temperature of 38.4°C (101.1°F). Which precaution should the nurse implement FIRST for this client?

  1. Place the client in a private room and perform strict hand hygiene before any contact, limiting visitors with illness
  2. Initiate contact precautions and don a gown and gloves for all room entry
  3. Obtain blood cultures from the central line and a peripheral site before administering any prescribed antibiotics (correct answer)
  4. Teach the client to avoid fresh flowers, raw fruits/vegetables, and salad bars
Explanation: This question tests infection control and preventive care for neutropenic clients. The priority concern is recognizing and treating potential sepsis in a severely neutropenic client with fever, which is a medical emergency. Obtaining blood cultures before antibiotics (C) is the most critical first action because neutropenic fever requires immediate evaluation for bacteremia and prompt antibiotic therapy, and cultures must be drawn before antibiotics to identify the causative organism. While placing the client in a private room with hand hygiene (A) and dietary restrictions (D) are important neutropenic precautions, they are not the immediate priority when fever is present; contact precautions (B) are not indicated for neutropenia alone. The principle of neutropenic precautions is that fever in a neutropenic patient (ANC <500/mm³) is an oncologic emergency requiring immediate cultures and antibiotics within one hour. A transferable strategy is to remember that any temperature ≥38.0°C (100.4°F) in a neutropenic patient requires immediate action: cultures first, then antibiotics.