A patient with cancer who is receiving chemotherapy develops a fever. The patient's chest radiograph is normal. The patient's neutrophil count is 750/mm3. The nurse expects the provider to:

Question

a. begin empiric therapy with intravenous antibiotics.
b. obtain cultures and wait for results before prescribing antibiotics.
c. order colony-stimulating factor to minimize neutrophilia.
d. reassure the patient that serious infection is unlikely.

Answer 1

ANS: A
In the absence of neutrophils, as occurs with bone marrow suppression in chemotherapy, fever is the principle sign of infection. Pus, abscesses, and infiltrates on a chest x-ray may all be absent. When a neutropenic patient develops an infection, immediate and vigorous intervention is required. Empiric IV antibiotic therapy should begin while waiting for laboratory results and cultures. It is not correct to wait for culture results before initiating antibiotic therapy. Colony-stimulating factor can minimize neutropenia but does not eliminate the need for IV antibiotics. It is not correct to reassure the patient that a serious infection is unlikely.