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Difficulty: MediumPharmacological Therapies

A client diagnosed with schizophrenia is scheduled to receive a morning dose of oral clozapine. Upon reviewing the electronic health record, the practical nurse notes that the client's most recent absolute neutrophil count (ANC) is 800/mm3800/\text{mm}^3. Which action should the nurse take first?

  1. Withhold the dose of clozapine and immediately notify the registered nurse.Answer
  2. B
    Administer the medication as prescribed and document the laboratory results in the client's chart.
  3. C
    Independently cancel the medication order in the electronic health record to prevent future administration.
  4. D
    Ask the client to state their name and administer the medication, bypassing barcode scanning to ensure prompt delivery.

Answer

Withhold the dose of clozapine and immediately notify the registered nurse.
Clozapine carries a black box warning for severe neutropenia and agranulocytosis. An absolute neutrophil count (ANC) of 800/mm3800/\text{mm}^3 is dangerously low. The practical nurse is legally and ethically responsible for reviewing relevant laboratory data prior to administration, withholding the medication if a critical abnormality is found, and promptly notifying the supervising registered nurse or provider.

Step-by-Step Solution

1
Identify the medication and its associated physiological risks.
Clozapine is an atypical antipsychotic known to cause agranulocytosis, which severely lowers the white blood cell and neutrophil counts.
Understanding the specific adverse effects of a medication is crucial for determining which client assessments and laboratory values require monitoring before administration.
2
Evaluate the client's current laboratory data against normal reference ranges.
The client's absolute neutrophil count (ANC) is 800/mm3800/\text{mm}^3, which is significantly below the normal range (typically 1,5001,500 to 8,000/mm38,000/\text{mm}^3).
Safe medication administration requires ensuring that the client's physiological status can safely tolerate the drug without life-threatening complications.
3
Determine the appropriate nursing intervention within the practical nurse (PN) scope of practice.
The PN must withhold the scheduled dose and immediately escalate the critical laboratory finding to the registered nurse or healthcare provider.
Administering the medication could lead to fatal infection due to severe immunosuppression, and independently altering orders exceeds the PN's legal scope of practice.

Key Concept

Monitoring adverse effects of medications and escalating critical laboratory values within the practical nurse scope of practice.
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Topics

Pharmacological Therapies

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