A nurse is reviewing the medical record of an adult client who has a fever and a prescription for acetaminophen.
Which of the following findings should the nurse identify as a contraindication for receiving this medication?

Clozapine is an antipsychotic medication that is used to treat schizophrenia and other psychotic disorders. It works by affecting the balance of certain chemicals in the brain.

Choice A is wrong because clozapine can cause weight gain, not weight loss, in some people. This can increase the risk of diabetes, high cholesterol, and heart problems. The nurse should advise the client to monitor their weight regularly and to follow a healthy diet and exercise plan.

Choice B is wrong because ringing in the ears (tinnitus) is not an expected adverse effect of clozapine. However, clozapine can cause other ear problems, such as otitis media (middle ear infection) or otitis externa (outer ear infection). The nurse should instruct the client to report any ear pain, discharge, or hearing loss to their provider.

Choice D is wrong because diarrhoea is not a common adverse effect of clozapine. However, clozapine can cause constipation, which can be severe and lead to bowel obstruction or perforation. The nurse should advise the client to drink plenty of fluids, eat high-fibre foods, and use laxatives as prescribed by their provider.

Choice C is correct because fever is a serious adverse effect of clozapine that may indicate a life-threatening condition called

agranulocytosis. Agranulocytosis is a severe reduction in white blood cells that can impair the immune system and increase the risk of infections. The nurse should instruct the client to notify their provider immediately if they develop a fever or any signs of infection, such as sore throat, cough, or flu-like symptoms. The client should also have regular blood tests to monitor their white blood cell count while taking clozapine.

The nurse should instruct the client to avoid drinking beverages while sucking on a nicotine lozenge because this can interfere with the absorption of nicotine and reduce its effectiveness. Some possible explanations for the other choices are:

Choice B is wrong because chewing nicotine gum for 10 minutes before spitting it out is too short.

The recommended duration is at least 30 minutes to allow enough nicotine to be released and absorbed through the lining of the mouth.

Choice C is wrong because changing the nicotine patch every other day is not frequent enough.

The patch should be changed daily and applied to a different skin site to prevent irritation and ensure a steady dose of nicotine.

Choice D is wrong because administering 2 sprays of nicotine nasal spray in each nostril with each dose is too much.

The recommended dose is one spray per nostril, up to five times per hour or 40 times per day.

Using too much nasal spray can cause side effects such as nasal irritation, sneezing, coughing, headache, or nausea.