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Neutropenic sepsis is time critical. Mortality rises with each hour of antibiotic delay. Immediate actions include obtaining blood cultures (peripheral and from any central line), measuring lactate, initiating broad-spectrum antipseudomonal coverage within 60 minutes, and aggressive crystalloid resuscitation (≈30 mL/kg) with reassessment of perfusion. Add MRSA coverage (e.g., vancomycin) when indicated—hemodynamic instability, catheter infection, pneumonia, or severe mucositis. Early source control (e.g., drainage) and vasopressors for persistent hypotension follow established sepsis bundles. Deferring antibiotics for imaging (Option A) or cultures (Option D) is unsafe. Monotherapy with vancomycin (Option B) lacks gram-negative and Pseudomonas coverage. APRN responsibilities include activating sepsis/neutropenic fever pathways, rapid triage, allergy verification, dose adjustments for organ dysfunction, and early consultation with infectious diseases. Continuous monitoring, daily de-escalation based on culture data, and growth-factor support in select patients complete the initial management bundle.