An oncology patient undergoing aggressive chemotherapy has an absolute neutrophil count critically low and a WBC of 3000. During morning rounds, the nurse notes a temperature of 38.1°C (100.6°F), blood pressure 92/58 mmHg, heart rate 112 bpm, and mild confusion. Which action is the nurse’s priority?

This oncology patient presents with classic signs of sepsis: temperature of 38.1°C, hypotension (92/58 mmHg), tachycardia (112 bpm), and altered mental status (mild confusion). In the context of a critically low absolute neutrophil count, febrile neutropenia with suspected sepsis constitutes a medical emergency. The priority action is to activate the sepsis protocol and obtain blood cultures before initiating antibiotics, because the Surviving Sepsis Campaign and institutional sepsis bundles mandate that cultures be drawn first to allow identification of the causative organism and to guide antibiotic de-escalation — but antibiotic therapy must then follow within one hour. Obtaining cultures after starting antibiotics is incorrect because antibiotics can render blood cultures falsely negative, eliminating the opportunity to identify the pathogen and tailor therapy. Initiating neutropenic precautions alone is insufficient as a first response once hemodynamic instability and signs of systemic infection are already present; precautions are preventive measures, not treatment. Administering acetaminophen addresses fever only and does not treat the life-threatening septic process or prevent further deterioration. The clinical picture — hypotension, tachycardia, fever, and confusion in a neutropenic patient — demands immediate recognition and management of sepsis, making activating the sepsis protocol with cultures the correct priority.