An older adult who takes clozapine (Clozaril) has schizophrenia and a surgical wound. Which laboratory test is the nurse's priority to evaluate before administering the clozapine to this individual?
a. White blood cell count
b. 2-hour urine for sodium
c. Unconjugated bilirubin
d. Clozapine serum level
A
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A Correct. The nurse must check the older adult's white blood cell count (WBC) before administering clozapine (Clozaril) because it is associated with agranu-locytosis. This is important for an older adult with an existing wound because immune system function can decline with age and clozapine-associated agranu-locytosis can develop suddenly. If this older adult develops agranulocytosis, he or she would be virtually defenseless against pathogens invading the wound and potentially could develop a serious infection.
B Incorrect. A timed urine test for sodium gives information about renal function; however, renal dysfunction is not usually associated with clozapine administra-tion.
C Incorrect. Unconjugated bilirubin is a measure of free serum bilirubin and a test for liver function. Hyperbilirubinemia can indicate liver dysfunction and drug toxicity, but liver dysfunction associated with clozapine is not common.
D Incorrect. Checking the clozapine serum level is a reasonable test for the nurse to check, if this test is available; however, because agranulocytosis associated with clozapine can occur suddenly, the WBC is the most important test to check.
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