A nurse is reviewing the laboratory results of a 5-year-old child who is receiving chemotherapy and has an absolute neutrophil count of 498/mm3 (2,500 to 8,000/mm3). Which of the following actions should the nurse take?

Children receiving chemotherapy are at risk for bone marrow suppression, which commonly results in neutropenia, defined by a decreased absolute neutrophil count (ANC). An ANC of 498/mm³ indicates severe neutropenia, placing the child at high risk for infection. Nursing care focuses on infection prevention, minimizing exposure to pathogens, and maintaining meticulous but gentle hygiene practices. Oral care is especially important because the mucosa can serve as an entry point for infection. Rationale: A. Encouraging the use of a soft sponge toothbrush supports oral hygiene while minimizing trauma to the oral mucosa, which is critical in a neutropenic child. Gentle cleaning helps reduce bacterial colonization without causing bleeding or mucosal injury that could increase infection risk. This intervention aligns with infection prevention strategies in immunocompromised patients. B. Assessing for petechiae and ecchymosis is more relevant to thrombocytopenia rather than neutropenia. Chemotherapy can cause multiple cytopenias, but the given laboratory value specifically reflects neutropenia, which increases infection risk rather than bleeding risk. Therefore, this is not the priority intervention based on the provided data. C. Preparing to administer factor VII concentrate is inappropriate because factor VII is used to treat specific coagulation disorders or bleeding due to clotting factor deficiencies. It has no role in managing neutropenia caused by chemotherapy. The child’s condition relates to low white blood cells, not coagulation abnormalities. D. Obtaining a prescription for an iron supplement is not indicated because neutropenia is not related to iron deficiency. Iron supplementation is used in cases of anemia due to low hemoglobin or iron stores, not for reduced neutrophil counts. The priority in this case is infection prevention rather than hematinic therapy.