A nurse is reviewing the medical record of a male client who has schizophrenia and is taking clozapine. Which of the following findings should the nurse identify as a contraindication to the administration of clozapine?

Fasting blood glucose 124 mg/dL (70 to 110 mg/dL)

Absolute neutrophil count 1,300/mm3 (2,500 to 8,000/mm3)

Heart rate 58/min

Hgb 12.5 g/dL (14 to 18 g/dL)

Answer and Explanation

The Correct Answer is B

A.   Elevated fasting blood glucose is a concern but does not immediately contraindicate clozapine administration. It can be monitored and managed.
B.   Clozapine can cause agranulocytosis, and a low absolute neutrophil count (ANC) is a contraindication for the medication. The threshold for stopping clozapine is typically an ANC of less than 1,500/mm3.
C.   A heart rate of 58/min is not a contraindication for clozapine. It may require monitoring but is not necessarily concerning.
D.   An Hgb level of 12.5 g/dL is within the normal range and does not contraindicate the use of clozapine.

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Correct Answer is D

Explanation

A. High-osmolarity formulas can cause gastrointestinal distress, but they do not directly increase the risk of aspiration.
B. A residual of 65 mL is a normal finding and does not increase the risk of aspiration.
C. Sitting in a high-Fowler's position helps reduce the risk of aspiration by allowing gravity to assist with digestion.
D. A history of gastroesophageal reflux disease (GERD) can increase the risk of aspiration because it may lead to reflux of gastric contents into the esophagus, which can be inhaled into the lungs.

A. Place sterile gauze over areas of spilled solution within the sterile field. B. Remove the cap and place it sterile-side up on a clean surface. C. Hold the bottle in the center of the sterile field when pouring the solution. D. Hold the irrigation solution bottle with the label facing away from the palm of the hand.

Correct Answer is B

Explanation

A. Spilled solution should not be left on the sterile field. The sterile field should be maintained and any spills must be handled properly.
B. The cap should be placed sterile-side up to prevent contamination and preserve sterility.
C. The bottle should be held outside the sterile field to avoid contamination.
D. The label should be facing the palm to ensure the bottle is handled correctly without contaminating the sterile solution.

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System	Findings
General	Adult child accompanying parent reports decline in client, expressing concern over memory and thought process, appetite, and self-care. Adult child states, "My sibling and I hired help at home for my parent. We thought that would help but it has not. I found the title to the car today, signed over to me."
Physical	Client makes poor eye contact, speaks in a monotone voice, and has a lack of facial expression. Client reports sleeping 7 hr a night and getting up "once or twice per night to go to the bathroom." Client reports not wanting to eat anymore. Client's child reports their parent has lost about 8 lb in the past month. Heart rate 68/min
Affect	Client says, "Why don't you just leave me? I am of no use."

A nurse is reviewing the medical record of a male client who has schizophrenia and is taking clozapine. Which of the following findings should the nurse identify as a contraindication to the administration of clozapine?

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