Question

a nurse is reviewing the medical record of a client who has schizophrenia and a prescription for clozapine. which of the following laboratory tests should the nurse review before administering the medication?

troponin
total cholesterol
creatinine
thyroid stimulating hormone

Explanation:

Identify the medication and its class

The question asks about clozapine, an atypical (second-generation) antipsychotic medication prescribed for treatment-resistant schizophrenia.

Analyze adverse effects and monitoring requirements

Clozapine is associated with several severe adverse effects, including agranulocytosis (requiring absolute neutrophil count monitoring), myocarditis, seizures, and severe metabolic side effects. Atypical antipsychotics, particularly clozapine and olanzapine, carry a high risk of causing metabolic syndrome, which includes significant weight gain, dyslipidemia, and hyperglycemia.

Evaluate the given options

• Troponin: Used to detect acute myocardial injury. While clozapine can cause myocarditis, troponin is not a routine baseline or pre-administration screening test unless cardiac symptoms are present.
• Total cholesterol: Clozapine carries a high risk of causing severe metabolic changes, including hyperlipidemia, hyperglycemia, and weight gain. Baseline and periodic monitoring of a lipid panel (including total cholesterol) and fasting blood glucose is essential.
• Creatinine: Used to evaluate renal function. Clozapine is primarily metabolized by the liver and does not require routine renal function monitoring.
• Thyroid stimulating hormone: Used to monitor thyroid function (commonly monitored for lithium therapy, not clozapine).

Determine the most appropriate pre-administration test

Among the choices provided, Total cholesterol is the correct laboratory test to review because of clozapine's high risk for causing metabolic syndrome and dyslipidemia. Note that while hematologic monitoring (ANC) is the most critical safety monitoring parameter for clozapine, it is not listed among the options. Therefore, total cholesterol is the correct choice from the available options.

Answer:

• Troponin
• Total cholesterol (Correct answer)
• Creatinine
• Thyroid stimulating hormone