An adult client in an inpatient psychiatric unit receives scheduled clozapine for treatmen… — NCLEX-PN

An adult client in an inpatient psychiatric unit receives scheduled clozapine for treatment-resistant schizophrenia. During the morning medication pass, the practical nurse observes that the client has a new-onset temperature of $101.4^\circ\text{F}$ ( $38.6^\circ\text{C}$ ), severe pharyngitis, and marked lethargy. The morning laboratory report indicates a white blood cell (WBC) count of $1,800/\text{mm}^3$ ( $1.8 \times 10^9/\text{L}$ ). Based on these findings, which action should the practical nurse take first?

Withhold the scheduled dose of the medication and immediately report the clinical findings and laboratory results to the registered nurse.Answer
B
Administer the scheduled medication and document the abnormal laboratory values in the client's electronic health record.
C
Perform a comprehensive, independent physical assessment to determine if the medication should be permanently discontinued.
D
Administer an as-needed analgesic to relieve the throat pain and ensure the client rests comfortably in bed.

Answer

The correct action is to withhold the scheduled dose of the medication and immediately escalate the clinical findings to the supervising registered nurse.

Clozapine is an atypical antipsychotic associated with a significant risk of agranulocytosis, a potentially fatal drop in white blood cells. A WBC count of

1,800/\text{mm}^3

(

1.8 \times 10^9/\text{L}

), combined with signs of infection such as fever and pharyngitis, strongly indicates this adverse effect. The safest and most appropriate action within the practical nurse scope of practice is to withhold the offending agent and immediately escalate the critical findings to the registered nurse for urgent medical intervention.

Step-by-Step Solution

Analyze the client's presenting symptoms and laboratory results.

The client has a fever, pharyngitis, and a critically low WBC count of

1,800/\text{mm}^3

(normal is typically

4,500

11,000/\text{mm}^3

Identifying abnormal clinical and laboratory findings is the foundational step in safe medication administration.

Correlate the assessment findings with the prescribed pharmacological therapy.

Clozapine carries a severe risk for agranulocytosis, a dangerous depletion of white blood cells that compromises the immune system.

Connecting the drug to its potential life-threatening adverse effect determines the required clinical intervention.

Determine the priority action within the practical nurse's scope of practice.

The nurse must withhold the drug to prevent further harm and immediately report the findings to the registered nurse.

Administering the medication would worsen the life-threatening condition, and independent medical or complex assessment decisions fall outside the practical nursing scope.

Key Concept

Pharmacological Therapies

Question

Answer

Step-by-Step Solution

Key Concept

Common Mistakes

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