A client with schizophrenia is started on clozapine. Which periodic measurements take priority in this client?

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Clozapine (Clozaril) is an atypical antipsychotic medication used to treat schizophrenia that has not responded to standard, more traditional treatment. Clozapine is associated with a risk for agranulocytosis (a potentially fatal blood disorder causing a dangerously low WBC count) and is therefore used only in clients with treatment-resistant schizophrenia. A client must have a WBC count of ≥3500/mm³ (3.5 × 10⁹/L) and an absolute neutrophil count (ANC) of ≥2000/mm³ (2 × 10⁹/L) before starting clozapine, so it is critical to obtain a baseline complete blood count and ANC. Because agranulocytosis is reversible if caught early, the client's WBC count and ANC must also be monitored regularly throughout the course of clozapine therapy (initially once a week) (Option A). Clients should also contact the health care provider immediately if they develop fever or sore throat, which can indicate infection due to neutropenia. (Option B) ECG and blood pressure monitoring is performed before therapy initiation and periodically during therapy because prolonged QT interval and orthostatic hypotension are potential side effects of clozapine; however, agranulocytosis poses a more significant danger to the client. (Options C and D) Hyperglycemia, dyslipidemia, and weight gain are potential side effects of clozapine therapy but are not as serious as agranulocytosis. Educational objective: Agranulocytosis, a serious adverse effect of clozapine, is potentially fatal. Pretreatment assessment and ongoing monitoring of WBC and absolute neutrophil counts are critical. Clients should contact the health care provider if they develop fever or sore throat, which can indicate infection due to neutropenia.

A Client with Schizophrenia Is Started on Clozapine