A nurse is reviewing the medical record of a client who is taking clozapine. Which of the following findings should the nurse report to the provider immediately?

BMI of 28

Fasting blood glucose 180 mg/dL (70 to 110 mg/dL)

LDL 220 mg/dL (less than 130 mg/dL)

WBC count 2,500/mm3 (5,000 to 10,000/mm3)

Answer and Explanation

The Correct Answer is D

Clozapine is an atypical antipsychotic used for treatment-resistant schizophrenia. It carries a black box warning for agranulocytosis, a severe reduction in granulocytes that predisposes patients to fatal sepsis. Monitoring the absolute neutrophil count and leukocyte levels is a mandatory safety requirement for this therapy.

Rationale:

A. A BMI of 28 indicates that the client is overweight, which is a common metabolic side effect of clozapine therapy. While weight gain should be managed through diet and lifestyle interventions, it does not represent an acute, life-threatening emergency. The nurse should document this finding but prioritize more urgent hematological complications during the assessment.

B. A fasting blood glucose of 180 mg/dL indicates hyperglycemia, reflecting the metabolic dysregulation often induced by second-generation antipsychotics. Clozapine can cause insulin resistance and new-onset diabetes mellitus. While this requires medical management and potential pharmacotherapy, it is not as immediately life-threatening as the risk of profound immunosuppression and systemic infection.

C. An LDL level of 220 mg/dL signifies hyperlipidemia, which increases the long-term risk of cardiovascular disease in patients taking clozapine. Dyslipidemia is a recognized adverse effect of the medication's impact on metabolic pathways. Although this value requires follow-up and statin therapy, it does not necessitate immediate notification compared to an urgent hematological crisis.

D. A WBC count of 2,500/mm3 is a critical finding indicating severe leukopenia and a high risk for agranulocytosis. This condition compromises the immune system, making the client highly vulnerable to life-threatening infections. The nurse must report this to the provider immediately, withhold the medication, and initiate protective isolation protocols to prevent the development of sepsis.

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Correct Answer is B

Explanation

Ototoxicityis a serious adverse effect of certain drug classes that results in damage to the cochlea or vestibular apparatus. Aminoglycosidesare well-known for this risk, potentially causing permanent sensorineural hearing loss or equilibrium disturbances. Monitoring drug trough levelsis a critical nursing intervention to minimize the accumulation of these drugs in the inner ear.

Rationale:

A.Rifampin is an antitubercular agent primarily known for hepatotoxicity and causing a harmless orange discoloration of body fluids. It is not associated with eighth cranial nerve damage or hearing loss. While it has many drug interactions, the nurse would prioritize monitoring liver function tests rather than auditory acuity for a client receiving this specific antibiotic medication.

B.Gentamicin is an aminoglycoside antibiotic that is highly ototoxic and nephrotoxic. It can cause irreversible damage to the hair cells in the organ of Corti, leading to progressive hearing loss or tinnitus. The nurse must monitor the client for any changes in hearing or balance and ensure that serum peak and trough levels remain within the safe therapeutic range.

C.Ciprofloxacin is a fluoroquinolone antibiotic that carries a boxed warning for tendon rupture and peripheral neuropathy, but it is not typically ototoxic. While it can cause central nervous system effects like dizziness, it does not target the auditory system. The nurse should focus on teaching the client about photosensitivity and avoiding minerals that interfere with the drug's absorption.

D.Penicillin G is a beta-lactam antibiotic with a wide safety margin, primarily carrying risks for hypersensitivity and allergic reactions. It does not cause damage to the ears or hearing loss. If a client on Penicillin G experiences symptoms, the nurse should assess for signs of anaphylaxis or skin rashes rather than focusing on auditory or vestibular functioning.

A. Methotrexate B. /B. Estrogen C. Esomeprazole D. Metformin

Correct Answer is A

Explanation

The shingles vaccine (specifically live attenuated versions) is contraindicated or requires caution in individuals who are immunocompromised. Certain medications exert an immunosuppressiveeffect by interfering with cellular replication or the inflammatory response, which can lead to uncontrolled viral replicationof the vaccine strain in the host.

Rationale:

A.Methotrexate is an immunosuppressant and antimetabolite that inhibits dihydrofolate reductase, leading to reduced white blood cell activity. Because the vaccine for shingles (Zostavax) contains live virus, patients on methotrexate may not be able to mount an appropriate immune response or may develop the infection. Caution or contraindication is necessary depending on the dose and the specific type of vaccine.

B.Estrogen replacement therapy does not significantly alter the immune system's ability to respond to vaccines. It is a hormone used to manage menopausal symptoms or osteoporosis and does not cause the leukopenia or immunosuppression associated with chemotherapy or autoimmune treatments. There is no contraindication for shingles immunization based on the use of estrogen medications in an adult client.

C.Esomeprazole is a proton pump inhibitor used to reduce gastric acid secretion and treat gastroesophageal reflux disease. It does not have any systemic effect on the immune response or the efficacy of viral vaccines. Patients taking esomeprazole can safely receive the shingles vaccine without additional precautions regarding their immunological status or ability to process the immunization.

D.Metformin is an oral antidiabetic agent that improves insulin sensitivity and has no known immunosuppressive properties. It does not interfere with the body's ability to produce antibodies or manage the live attenuated virus found in certain vaccines. Therefore, a prescription for metformin would not serve as a reason for caution when scheduling a shingles immunization for a senior client.

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A nurse is reviewing the medical record of a client who is taking clozapine. Which of the following findings should the nurse report to the provider immediately?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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Explanation

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