A 33-year-old woman with schizophrenia comes in for a refill of clozapine (Clozaril). Her most recent lab report shows an absolute neutrophil count (ANC) of 1,100/μL. What action should the psychiatric mental health nurse practitioner (PMHNP) take?
Recommend hematology consultation
Continue treatment
Interrupt treatment for suspected clozapine-induced neutropenia
Suspend treatment
The Correct Answer is C
Choice A reason: While a hematology consultation may be appropriate in severe or persistent cases, the immediate action required at an ANC of 1,100/μL is to interrupt clozapine therapy due to the risk of agranulocytosis. This value falls below the threshold for safe continuation.
Choice B reason: Continuing treatment at an ANC of 1,100/μL is contraindicated. Clozapine carries a risk of severe neutropenia, and guidelines recommend interruption of therapy when ANC drops below 1,500/μL, with more urgent action below 1,000/μL.
Choice C reason: Interrupting treatment is the correct action. An ANC of 1,100/μL indicates moderate neutropenia, and clozapine should be paused to prevent progression to agranulocytosis. Monitoring and potential re-initiation may follow depending on recovery.
Choice D reason: Suspending treatment implies a more permanent cessation. While this may be necessary if neutropenia worsens or recurs, the initial step at this ANC level is interruption, not full suspension.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: PANSS is not a self-report tool. It is a clinician-administered scale that requires structured interviews and observation. Patients do not complete it independently.
Choice B reason: While PANSS does assess both positive and negative symptoms, this answer is incomplete. PANSS also includes a third domain—general psychopathology—which encompasses symptoms like anxiety, depression, and cognitive impairment.
Choice C reason: PANSS is comprehensive and takes time to administer. It includes 30 items rated on a 7-point scale and requires clinical expertise, making it more complex than brief screening tools.
Choice D reason: PANSS is distinct in its tripartite structure, measuring positive symptoms (e.g., hallucinations, delusions), negative symptoms (e.g., blunted affect, social withdrawal), and general psychopathology (e.g., anxiety, poor impulse control). This multidimensional approach provides a thorough evaluation of schizophrenia.
Correct Answer is C
Explanation
Choice A reason: Carcinomas are typically hard, irregular, immobile, and may be associated with skin changes or nipple retraction. While breast cancer must always be ruled out, the described mass lacks the suspicious features of malignancy.
Choice B reason: A clogged duct is usually painful and associated with lactation. It presents as a tender, localized area of swelling and is not typically rubbery or mobile. This patient is nulligravid and not lactating, making this diagnosis unlikely.
Choice C reason: Fibroadenomas are common benign breast tumors in young women. They are typically smooth, round, rubbery, mobile, and nontender. The location in the upper outer quadrant and the described characteristics strongly suggest a fibroadenoma.
Choice D reason: Duct ectasia involves dilation of the milk ducts and may present with nipple discharge, tenderness, or inflammation. It is more common in older women and does not typically present as a discrete, mobile mass.
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