The most recent blood count for a child who has received chemotherapy last week shows neutropenia. The priority nursing diagnosis for this child is:

Choice A rationale Neutropenia is defined as an abnormally low number of neutrophils, typically an absolute neutrophil count (ANC) below 1,500 cells/mm&sup3; for children, and often < 500 cells/mm&sup3; following chemotherapy. Neutrophils are the primary defense against bacterial and fungal infections. A severely reduced count significantly compromises the child's immune response, making the risk for systemic infection the most immediate and life-threatening priority nursing diagnosis. Choice B rationale While chemotherapy can cause thrombocytopenia (low platelet count, normal range 150,000–450,000/mm&sup3;), which leads to a risk for hemorrhage, the problem described is specifically neutropenia (low neutrophil count, normal range 1,500–8,000/mm&sup3;). Therefore, the priority related to a low white cell count is the risk for overwhelming infection, not necessarily bleeding risk. Choice C rationale Chemotherapy can cause stomatitis, dry skin, and mucosal damage, leading to altered skin and mucous membrane integrity, which further increases the risk of infection. However, the direct consequence of neutropenia is a systemic immune deficit, making the risk for infection a broader and higher-priority diagnosis than just local skin breakdown. Choice D rationale Changes in physical appearance (like hair loss or weight changes) and the effects of illness can lead to disturbance in body image. This is an important psychosocial nursing diagnosis. However, in Maslow's hierarchy of needs, physiological needs (like preventing life-threatening infection due to neutropenia) must take priority over psychosocial needs.