The nurse assesses a client with a history of idiopathic thrombocytopenia purpura who had a splenectomy eight weeks ago. Which assessment finding is most concerning?

Rationale: A. A temperature of 38.4°C (101.1°F) represents fever, which is highly concerning in a client who has undergone a splenectomy. The spleen plays a critical role in filtering bacteria from the blood and mounting an immune response, particularly against encapsulated organisms such as Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis. After splenectomy, clients are at increased risk for overwhelming post-splenectomy infection (OPSI), which can progress very rapidly and be life-threatening. Early signs often include fever, malaise, or mild flu-like symptoms, but sepsis can develop quickly. Prompt assessment, blood cultures, and initiation of empiric antibiotics are essential to prevent severe complications or death. B. Engaging in unprotected sex increases the risk of sexually transmitted infections (STIs). While this is a health concern that warrants patient education and screening, it is not immediately life-threatening and does not pose the same acute risk as infection in an asplenic client. C. Daily marijuana use may affect cognitive function, respiratory health, or interact with other medications, but it is not an acute medical emergency. It requires counseling but is not a priority in the context of post-splenectomy care. D. A blood pressure of 136/76 mm Hg is slightly elevated but within a mild range and not acutely concerning. Hypertension does not pose the same immediate threat as infection in an asplenic client.