A patient who has been treated with clozapine (Clozaril) for 9 months calls to cancel a clinic appointment because of flulike symptoms, including a sore throat, fever, and tiredness
The nurse demonstrates the best understanding on the management of these symptoms when responding: a. "I think you need to drink lots of juices and water and go to bed. Call me at the end of the week to reschedule your appointment.".
b. "I want you to please keep the appointment, and I will arrange for some blood work to be done while you are here.".
c. "It's flu season all right. Get better soon, and call me to reschedule when you're feeling better.".
d. "This may be something much more serious than the flu. Go to the hospital at once.".
B
Although agranulocytosis occurs in only about 1% to 2% of patients, this is a risk 10 to 20 times greater than the risk with standard antipsychotic agents. In addition, even though the risk for this adverse effect decreases substantially after 5 months of taking these drugs, the risk always remains and requires vigilant monitoring. After the first 6 months, blood counts are drawn biweekly, so the nurse in the above situation would want to obtain one today to determine whether the patient is experiencing agranulocytosis or flu. Although this is a serious adverse effect, the nurse will provide specific instructions but endeavor not to alarm the patient. In addition, the fact that this patient is female and of an older age places her at increased risk for agranulocytosis.
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