A nurse is caring for a male client who is to begin therapy with valproic acid.
Which of the following diagnostic results should the nurse plan to review before administering the first dose?

Choice A rationale: Pupils

Dilated pupils are a common sign of stimulant intoxication, particularly with substances like methamphetamine. Given that the client recently injected an unknown substance, pupil dilation could indicate acute intoxication and require urgent evaluation to prevent potential overdose or complications.

Choice B rationale: Heart rate

A heart rate of 121–124/min is significantly elevated, suggesting tachycardia, which can be related to stimulant use (such as methamphetamine) or withdrawal effects. High heart rates, especially in the context of withdrawal, can increase the risk of arrhythmias or cardiac complications, requiring close monitoring and intervention.

Choice C rationale: Orientation

The client was oriented only to person upon admission, which suggests altered mental status. Substance intoxication or withdrawal can impair cognitive function, decision-making, and awareness, increasing the risk for agitation, confusion, or more severe withdrawal symptoms such as hallucinations or seizures.

Choice D rationale: Respiratory rate

A respiratory rate of 20/min falls within the normal range (typically 12–20 breaths per minute) and does not indicate immediate distress requiring escalation of care.

Choice E rationale: Medical history

While knowing the client’s medical history is important for long-term care planning, it does not require immediate reporting unless the client has a history of conditions that could complicate withdrawal.

Choice F rationale: Oxygen saturation

An oxygen saturation of 98% on room air is within normal limits, meaning oxygenation is adequate. There is no immediate concern requiring intervention based on this finding.

Choice A rationale: WBC count

Clozapine carries a risk of agranulocytosis, a severe reduction in white blood cell (WBC) count that can leave the body vulnerable to infections. The client’s WBC count of 4,800/mm³ is below the normal range (5,000–10,000/mm³), raising concern for compromised immune function. Since routine monitoring of WBC is necessary for clients on clozapine, the provider should be notified to reassess whether the medication should be continued or adjusted.

Choice B rationale: Blood glucose level

While the client’s blood glucose level of 200 mg/dL is elevated, atypical antipsychotics like clozapine can contribute to metabolic syndrome and insulin resistance. However, this is not an immediate reason to clarify the prescription unless hyperglycemia is significantly worsening or causing complications.

Choice C rationale: Blood pressure

A blood pressure of 110/68 mm Hg is within normal limits and does not necessitate clarification of the prescription. Clozapine may cause hypotension in some clients, but this reading does not indicate a concerning drop in blood pressure.

Choice D rationale: Temperature

A temperature of 37.8°C (100.0°F) is slightly elevated but does not independently warrant medication clarification. However, because fever plus a low WBC count raises the suspicion of infection, the provider should be informed of both findings to assess potential complications.