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Difficulty: HardPharmacological Therapies

An inpatient psychiatric unit receives morning laboratory results for a client managed on oral clozapine therapy. The report shows a white blood cell (WBC) count of 1,800/mm31,800/\text{mm}^3 and an absolute neutrophil count (ANC) of 400/mm3400/\text{mm}^3. Upon entering the room for morning care, the client complains of a painful sore throat and has an oral temperature of 100.8∘F100.8^\circ\text{F} (38.2∘C38.2^\circ\text{C}). Based on these findings, which action is most appropriate for the practical nurse to perform?

  1. Withhold the next dose of clozapine and urgently notify the registered nurse of the client's status.Answer
  2. B
    Administer a prescribed oral antipyretic for the fever and document the client's vital signs in the electronic health record.
  3. C
    Initiate an intravenous (IV) push dose of a broad-spectrum antibiotic to rapidly treat the suspected infection.
  4. D
    Administer the scheduled clozapine after verifying the client's room number, as the client is familiar to the nursing staff.

Answer

Withhold the next dose of clozapine and urgently notify the registered nurse of the client's status.
Withholding the medication and notifying the registered nurse is the correct action because the client is exhibiting classic signs of agranulocytosis (critically low WBC/ANC, fever, sore throat), a life-threatening adverse effect of clozapine. The practical nurse's scope of practice dictates holding the offending agent and immediately escalating unstable or critical findings to the registered nurse.

Step-by-Step Solution

1
Analyze the laboratory data and vital signs.
The WBC count (1,800/mm31,800/\text{mm}^3) and ANC (400/mm3400/\text{mm}^3) are critically low. The fever and sore throat are clinical signs of an active infection in an immunocompromised client.
Recognizing life-threatening adverse effects of pharmacological therapies is essential for safe client care.
2
Determine the pharmacological implications.
Clozapine is an atypical antipsychotic with a known, severe risk of drug-induced agranulocytosis (severe neutropenia).
The medication must be stopped immediately to prevent further bone marrow suppression and potentially fatal sepsis.
3
Apply the practical nurse scope of practice.
The practical nurse must withhold the scheduled medication and escalate the critical findings to the registered nurse or healthcare provider.
While practical nurses gather data and recognize abnormalities, they must report critical, unstable findings to the registered nurse for comprehensive assessment and medical intervention.

Key Concept

Clozapine Adverse Effects and LPN Scope of Practice
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Topics

Pharmacological Therapies

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