A client is prescribed 15 mg of fluoxetine daily. The medication is available in 10 mg tablets. How many tablets should be administered?

Choice A reason: Akathisia is a common extrapyramidal side effect characterized by subjective feelings of inner restlessness and an inability to sit still. While distressing and a risk factor for non-compliance or suicide, it is generally not acutely life-threatening compared to systemic syndromes involving autonomic instability and hyperpyrexia.

Choice B reason: Neuroleptic Malignant Syndrome (NMS) is a life-threatening idiosyncratic reaction to antipsychotic drugs. It is characterized by muscle rigidity, fever, autonomic instability, and altered mental status. Given the high mortality rate associated with NMS, the nurse must prioritize this medical emergency over non-lethal side effects of the medication.

Choice C reason: Serotonin syndrome is a potentially life-threatening condition caused by excessive serotonergic activity, often associated with SSRIs. While critical, the use of first-generation antipsychotics significantly elevates the specific risk for NMS. The nurse must distinguish between these syndromes, but NMS is the primary concern when potent dopamine antagonists are used.

Choice D reason: Extrapyramidal symptoms (EPS) encompass a range of movement disorders, including dystonia and pseudoparkinsonism. While these are frequent side effects of first-generation antipsychotics, they are typically manageable with dose adjustments or anticholinergic medications and do not carry the same immediate mortality risk as the systemic collapse seen in NMS.

Choice A reason: While tardive dyskinesia is a serious concern with many antipsychotics, clozapine is actually associated with a very low risk of this condition. In fact, clozapine is often used as a treatment strategy for patients who have already developed severe tardive dyskinesia from other neuroleptic medications.

Choice B reason: Clozapine has a unique pharmacological profile with low D2 receptor occupancy in the striatum, making extrapyramidal symptoms like tremors or rigidity highly unlikely. It is specifically chosen for patients who are treatment-resistant or highly sensitive to the motor side effects caused by other typical or atypical antipsychotics.

Choice C reason: Serotonin syndrome is a toxic state caused by excessive serotonergic activity, usually resulting from interactions between SSRIs, SNRIs, or MAOIs. While clozapine affects various neurotransmitter systems, it is not primarily associated with the development of serotonin syndrome, which presents with hyperreflexia, clonus, and autonomic instability.

Choice D reason: Agranulocytosis is a life-threatening reduction in the white blood cell count (specifically neutrophils) that can occur in patients taking clozapine. This requires strict mandatory blood monitoring of the Absolute Neutrophil Count (ANC) to prevent severe sepsis or death, making it the most critical safety priority for the nurse.