A client with leukemia who is receiving myelosuppressive chemotherapy has a platelet count of 25,000/mm3 (25 x 109/L). Which intervention is most important for the nurse to include in this client's plan of care?

Reference Range:

Platelet Count [150,000 to 400,000/mm3 (156 400 x 109/L)]

Here are the steps you can follow to calculate the infusion pump flow rate:

Step 1: Calculate the prescribed dose in mcg/min

1. Dose per weight: 2 mcg/kg/min * 60 kg = 120 mcg/min

Step 2: Convert the concentration in the IV bag to mcg/mL

1. Convert mg to mcg: 200 mg * 1000 mcg/mg = 200,000 mcg
2. Concentration: 200,000 mcg / 250 mL = 800 mcg/mL

Step 3: Calculate the flow rate in mL/min

1. Flow rate: 120 mcg/min / 800 mcg/mL = 0.15 mL/min

Step 4: Convert the flow rate to mL/hour

1. Hour conversion: 0.15 mL/min * 60 min/hour = 9 mL/hour

Therefore, the nurse should program the infusion pump to deliver 9 mL/hour.

The correct answer is Choice D

Choice A rationale: Splinting with a pillow may reduce discomfort during movement or coughing by stabilizing the incision site, but it does not address acute postoperative pain with sympathetic overdrive. The elevated heart rate, respiratory rate, and blood pressure suggest a stress response mediated by catecholamines. Without analgesia, nociceptive signals continue to activate the hypothalamic-pituitary-adrenal axis. While splinting is supportive, it lacks the pharmacologic efficacy needed to blunt nociceptive transmission at the spinal or supraspinal level.

Choice B rationale: Assessing IV patency is a procedural prerequisite for medication administration but not a therapeutic intervention in itself. It does not directly address the pathophysiology of acute pain or the sympathetic surge evidenced by tachycardia and hypertension. Pain activates ascending pathways via A-delta and C fibers, requiring pharmacologic blockade. IV access assessment is necessary but secondary to the urgent need for analgesia to prevent complications like hypoxia, hyperventilation, or delayed recovery.

Choice C rationale: High Fowler positioning may improve diaphragmatic excursion and reduce pulmonary complications, but it does not mitigate visceral or incisional pain. In fact, increased intra-abdominal pressure from upright posture may exacerbate pain at the surgical site. Pain perception involves central sensitization and peripheral nociceptor activation, which are unaffected by positioning. The client’s pale skin and elevated vitals indicate systemic distress requiring analgesic intervention, not postural adjustment. Thus, this choice lacks direct analgesic benefit.

Choice D rationale: IV analgesics act rapidly to inhibit nociceptive transmission at the spinal cord and brainstem levels. Opioids bind to mu receptors, reducing neurotransmitter release and hyperpolarizing neurons, thereby dampening pain signals. This intervention directly targets the physiologic cause of elevated heart rate, respiratory rate, and blood pressure. Normal heart rate is 60–100 bpm, respiratory rate 12–20 breaths/min, and BP <120/80 mmHg. Prompt analgesia prevents complications like hypoxia, delayed healing, and neuroendocrine stress