A female client with cancer is receiving chemotherapy and develops thrombocytopenia.
The nurse identifies which intervention as the highest priority in the nursing plan of care?

Choice A rationale

Filgrastim (Neupogen) is a granulocyte colony-stimulating factor (G-CSF) that stimulates the production, maturation, and activation of neutrophils within the bone marrow. In patients undergoing chemotherapy with low white blood cell counts, particularly neutropenia, filgrastim is crucial for accelerating neutrophil recovery and reducing the incidence, severity, and duration of febrile neutropenia, thereby minimizing infection risk.

Choice B rationale

Epoetin alfa (Epogen) is an erythropoiesis-stimulating agent (ESA) that promotes red blood cell production. While chemotherapy can cause anemia, epoetin alfa specifically targets erythropoiesis and would not address a low white blood cell count. Its primary indication is for the treatment of chemotherapy-induced anemia, not neutropenia.

Choice C rationale

Vancomycin (Vancocin) is an antibiotic primarily used to treat serious bacterial infections, especially those caused by Gram-positive bacteria like methicillin-resistant Staphylococcus aureus (MRSA). It directly combats existing infections and does not stimulate the production of white blood cells. Administering an antibiotic would be appropriate for an infection, not to increase a low white blood cell count.

Choice D rationale

Vincristine (Oncovin) is a vinca alkaloid chemotherapy agent itself, commonly used in the treatment of various cancers. It works by inhibiting microtubule formation, leading to cell cycle arrest and apoptosis of rapidly dividing cells, including cancer cells. Administering another chemotherapy agent would further suppress bone marrow function, exacerbating a low white blood cell count, rather than improving it.

Choice A rationale

An advance directive is a legal document that articulates a person's wishes regarding medical treatment, not to empower family members to make all decisions without guidance. While family may be involved in discussions, the primary purpose is to ensure the individual's autonomy in healthcare decisions, especially when they lose the capacity to communicate their preferences, thereby guiding surrogate decision-makers according to the patient's previously stated desires and values.

Choice B rationale

An advance directive is a legally binding document that enables an individual to specify their healthcare preferences, such as the desire for or refusal of life-sustaining treatments, in the event they become incapacitated. This mechanism ensures that their autonomy and values are respected, allowing them to guide medical decisions even when they are no longer able to communicate directly, thereby alleviating the burden of decision-making on family members and healthcare providers.

Choice C rationale

An advance directive is a dynamic legal document that can be modified or revoked at any time by the competent individual. As a person's medical condition, values, or wishes may change over time, the ability to update the advance directive ensures that it accurately reflects their current preferences regarding medical treatment. Regular review and revision are encouraged to maintain its relevance and effectiveness.

Choice D rationale

Advance directives are beneficial for all adults, regardless of their health status or prognosis, as they facilitate proactive planning for potential future incapacitation. While often discussed in the context of terminal illness or hospice care, having an advance directive in place is a prudent measure for anyone to ensure their healthcare wishes are known and respected in unforeseen circumstances, such as accidents or sudden critical illness, promoting autonomy and reducing family distress.