A nurse is preparing to perform a follow-up assessment on a client who takes chlorpromazine (Thorazine) for the treatment of schizophrenia. The nurse should expect to find the greatest improvement in which of the following manifestations? Select all that apply.

Clozapine (Clozaril) is an atypical antipsychotic with a well-documented risk of agranulocytosis, a potentially life-threatening decrease in white blood cells (WBCs). Regular monitoring of WBC count is essential for early detection of this adverse effect and for ensuring patient safety during ongoing therapy. Nursing care includes educating the patient about infection signs and emphasizing the importance of adherence to scheduled lab testing.

Rationale for correct answer:

B. WBC count: Clozapine can cause agranulocytosis, which increases the patient’s risk for serious infections. Regular WBC monitoring is critical to detect decreases early and prevent complications. This includes baseline testing and weekly or biweekly checks during initial therapy, with gradual spacing as stability is achieved.

Rationale for incorrect answer:

A. Platelet count: While important for general hematologic monitoring, clozapine specifically affects WBCs, not platelets, so routine platelet checks are not the primary safety measure.

C. Liver function studies: Liver function may be monitored periodically, but hepatotoxicity is less common and not the primary concern with clozapine.

D. Renal function studies: Clozapine is not nephrotoxic, and routine renal monitoring is not a standard requirement for safety.

Take-home points:

• Clozapine carries a high risk of agranulocytosis; WBC monitoring is essential.
• Patients should report fever, sore throat, or signs of infection immediately.
• Monitoring schedules typically start weekly and may become less frequent if counts remain stable.

Antipsychotic medications, such as olanzapine, are used to treat psychotic disorders including schizophrenia and bipolar disorder by modulating dopamine and serotonin neurotransmission. Nurses must be able to identify antipsychotic agents to monitor for therapeutic effects, prevent adverse reactions, and provide accurate patient teaching regarding side effects and safety precautions.

Rationale for correct answer:

C. Olanzapine (Zyprexa)
This is an atypical antipsychotic that targets both dopamine and serotonin receptors, reducing positive symptoms like hallucinations and delusions, as well as some negative symptoms such as social withdrawal. Monitoring for weight gain, metabolic syndrome, and sedation is important during therapy.

Rationale for incorrect answer:

A. Lithium carbonate
Lithium is a mood stabilizer, primarily used in bipolar disorder, and does not directly treat psychotic symptoms. Its mechanism involves modulating neurotransmission, but it is not classified as an antipsychotic.

B. Sertraline (Zoloft)
Sertraline is a selective serotonin reuptake inhibitor (SSRI) used to treat depression and anxiety disorders. It is not an antipsychotic and does not target dopamine pathways involved in psychosis.

D. Amitriptyline (Elavil)
Amitriptyline is a tricyclic antidepressant used for depression and chronic pain, not for psychotic disorders. It affects norepinephrine and serotonin reuptake, not dopamine pathways.

Take-home points:

• Olanzapine is an atypical antipsychotic used for schizophrenia and bipolar disorder.
• Monitor for metabolic changes, sedation, and weight gain during therapy.
• Be able to differentiate antipsychotics from mood stabilizers and antidepressants for safe patient management.