A client who is receiving chemotherapy has these laboratory results: WBC 8,000/mm3, platelets 45,000/uL, hemoglobin 14 g/dL, hematocrit 46%. Which action should the nurse take first?

A client who is receiving chemotherapy has these laboratory results: WBC 8,000/mm3, platelets 45,000/uL, hemoglobin 14 g/dL, hematocrit 46%. Which action should the nurse take first?

• A. Treat underlying infections
• B. Encourage increased intake of iron-rich foods
• C. Obtain a type and cross match for packed cells infusion
• D. Institute bleeding precautions

Answer: (D)

Low platelets from chemotherapy create a bleeding risk even when other counts look normal. Platelets are essential for forming clots to stop bleeding, and a count around 45,000 per microliter is well below the normal range (roughly 150,000–450,000). With this level, spontaneous or minor-trauma bleeding becomes more likely, so the immediate priority is to prevent bleeding by implementing bleeding precautions. This means careful handling to avoid injury, avoiding invasive procedures when possible, using gentle oral care (soft toothbrush, careful with floss), avoiding IM injections, applying firm pressure to any bleeding sites, monitoring for signs like petechiae or gum bleeding, and securing lines to reduce trauma. The other actions aren’t addressing the current risk. Treating infections is more pressing when neutropenia is present or there are signs of infection, but the WBC count is normal here. Iron-rich foods or iron supplementation isn’t needed with a normal hemoglobin and hematocrit. Transfusion decisions (such as crossmatching for packed cells) are guided by significant anemia or active bleeding; with a stable Hgb, transfusion isn’t the first step. The key point is that the low platelet count drives the immediate nursing action to reduce bleeding risk.

Low platelets from chemotherapy create a bleeding risk even when other counts look normal. Platelets are essential for forming clots to stop bleeding, and a count around 45,000 per microliter is well below the normal range (roughly 150,000–450,000). With this level, spontaneous or minor-trauma bleeding becomes more likely, so the immediate priority is to prevent bleeding by implementing bleeding precautions. This means careful handling to avoid injury, avoiding invasive procedures when possible, using gentle oral care (soft toothbrush, careful with floss), avoiding IM injections, applying firm pressure to any bleeding sites, monitoring for signs like petechiae or gum bleeding, and securing lines to reduce trauma.

The other actions aren’t addressing the current risk. Treating infections is more pressing when neutropenia is present or there are signs of infection, but the WBC count is normal here. Iron-rich foods or iron supplementation isn’t needed with a normal hemoglobin and hematocrit. Transfusion decisions (such as crossmatching for packed cells) are guided by significant anemia or active bleeding; with a stable Hgb, transfusion isn’t the first step. The key point is that the low platelet count drives the immediate nursing action to reduce bleeding risk.