A 68 year old woman diagnosed with thrombocytopenia due to acute lymphocytic leukemia is admitted to the hosp… - GMCH Chandigarh - 2019

GMCH Chandigarh - 2019

Medical & Surgical Nursing

Hard

Appeared in: GMCH Chandigarh - 2019

Explanation

Patients with acute lymphocytic leukemia (ALL) and those undergoing chemotherapy are severely immunocompromised, specifically neutropenic (low white blood cell count).
The primary nursing priority for a neutropenic patient is to prevent infection, which can be life-threatening.
A private room is a fundamental component of protective (reverse) isolation, minimizing the patient's exposure to pathogens from others.
This action directly addresses the most significant environmental risk to the patient's safety in a hospital setting.

Option A: The rationale provided ('to feel security') is a psychosocial need. While important, it is not the primary reason for a private room in this clinical situation. The primary reason is physiological safety.
Option C: Placing an immunocompromised patient in a semiprivate room is unsafe. It directly increases the risk of exposure to pathogens from a roommate. 'Stimulation' is a low-priority psychosocial need compared to the life-threatening risk of infection.
Option D: This is incorrect for the same reason as option C. It prioritizes a psychosocial need ('opportunity to express her feelings') over the critical safety need of infection prevention. A semiprivate room is contraindicated.

Clinical Relevance

Nursing practice connection: Use the key finding related to Infection control and protective isolation for immunocompromised patients to guide bedside assessment, documentation, and the next nursing action.
For any patient with leukemia or undergoing chemotherapy, nurses must assume they are neutropenic and implement protective precautions until lab results prove otherwise. Infection is a medical emergency in this population.
Nursing care for neutropenic patients includes strict hand hygiene, monitoring temperature closely (fever is a critical sign), and educating the patient and family about avoiding sources of infection (crowds, sick contacts, fresh fruits/vegetables/flowers).
What if the patient also had a productive cough and fever? In that case, the patient would need to be evaluated for an active infection. While still needing a private room, the rationale would expand to include protecting others (standard/droplet precautions) in addition to protecting the patient.

How to Approach the Question

First, identify the patient's primary diagnosis: Acute Lymphocytic Leukemia.
Recall the main complications of ALL and its treatment: immunosuppression (neutropenia/infection risk) and bone marrow failure (thrombocytopenia/bleeding risk, anemia).
Apply the principle of patient safety. The highest priority is to protect the patient from life-threatening complications.
Evaluate the options based on this priority. A private room minimizes infection risk, while a semiprivate room increases it.
Analyze the rationale for each option. The correct option must have both the right action (private room) and the right reason (infection prevention).
Eliminate options that propose an unsafe action (semiprivate room) or provide a weak, non-medical rationale for a correct action.

Concept Tested & Keywords

Concept Tested: Infection control and protective isolation for immunocompromised patients.
Stem keywords: thrombocytopenia, acute lymphocytic leukemia, admitted to the hospital, nurse should assign
Lead-in keywords: assign the patient to
Clinical cues: Patient has acute lymphocytic leukemia, which is a primary indicator for being immunocompromised.
Clinical cues: Patient is 68 years old, an age group that can have a less resilient immune response.

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