Examkin

Question

Difficulty: MediumPharmacological Therapies

A practical nurse is preparing to administer a scheduled morning dose of oral clozapine to a client diagnosed with schizophrenia. Prior to administration, the nurse reviews the client's most recent complete blood count (CBC) results, which indicate a white blood cell (WBC) count of 2,800/mm32,800/\text{mm}^3 and an absolute neutrophil count (ANC) of 900/mm3900/\text{mm}^3. Which of the following is the most appropriate action by the nurse?

  1. Withhold the dose of clozapine and immediately report the laboratory results to the registered nurse.Answer
  2. B
    Administer the medication as prescribed and closely monitor the client for signs of infection.
  3. C
    Calculate and administer a reduced dosage of the medication to minimize the risk of further bone marrow suppression.
  4. D
    Explain the risks of agranulocytosis to the client and obtain a new signed consent before administering the dose.

Answer

The nurse should withhold the medication and report the critical laboratory results to the registered nurse.
Clozapine can cause severe agranulocytosis. An ANC below 1,000/mm31,000/\text{mm}^3 indicates severe neutropenia. The standard protocol requires withholding the medication and immediately notifying the provider or registered nurse to initiate protective precautions and alternative treatment.

Step-by-Step Solution

1
Analyze the laboratory values.
The WBC count is 2,800/mm32,800/\text{mm}^3 (normal is typically 4,5004,500 to 11,000/mm311,000/\text{mm}^3) and the ANC is 900/mm3900/\text{mm}^3 (normal is greater than 1,500/mm31,500/\text{mm}^3).
Identifying abnormal laboratory results is essential before administering medications that can affect blood cell counts.
2
Correlate the laboratory findings with the prescribed medication.
Clozapine is an atypical antipsychotic known to cause agranulocytosis (severe neutropenia), which is life-threatening.
Understanding the adverse effects of clozapine guides safe administration practices.
3
Determine the appropriate nursing intervention based on scope of practice.
The nurse must withhold the medication and escalate the critical findings to the supervising registered nurse or healthcare provider.
Administering the medication could lead to fatal infection, and adjusting the dose or bypassing escalation is outside the practical nurse's scope.

Key Concept

Clozapine requires strict monitoring of WBC and ANC due to the risk of agranulocytosis; critical lows require withholding the drug and immediate escalation.
Rate this question

Topics

Pharmacological Therapies

More questions from this topic