A nurse is preparing to administer fluphenazine 7.5 mg PO daily to a client who has schizophrenia.

Available is fluphenazine elixir 2.5 mg/5 mL. How many mL should the nurse administer?

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.

Choice A rationale

Keeping the client's room dark at night can worsen delirium by reducing environmental cues and potentially increasing disorientation and fear. Clients with delirium benefit from a well-lit environment that helps them maintain a sense of reality and reduces the risk of misinterpreting stimuli.

Choice B rationale

Limiting the client's need to make decisions can decrease their sense of control and autonomy, potentially increasing agitation and frustration associated with delirium. While simplifying choices is helpful, completely eliminating decision-making can be counterproductive to their engagement and orientation.

Choice C rationale

Discouraging visitation from the client's family can increase the client's feelings of isolation and anxiety, which can exacerbate delirium. Familiar faces and voices can provide comfort and reassurance, aiding in orientation and reducing agitation.

Choice D rationale

Providing a consistent daily routine helps to orient the client with acute delirium to time and place, reducing confusion and anxiety. Predictable patterns of activity, such as meals, hygiene, and rest, offer structure and familiarity, which can stabilize cognitive function and promote a sense of security.