A nurse is reviewing the medical record of a 50-year-old male client who has schizophrenia in an inpatient mental health facility

Exhibits

Which of the following findings should the nurse report to the provider? (Select all that apply.)

Rationales for Each Condition

Opioid Intoxication

1. Sedation: Opioids cause central nervous system depression, leading to drowsiness, confusion, and reduced level of consciousness.
2. Pinpoint Pupils: A hallmark sign of opioid intoxication is miosis (pinpoint pupils) due to parasympathetic nervous system activation.

Stimulant Intoxication (e.g., Methamphetamine)

1. Seizures: Stimulants can lower the seizure threshold, increasing the risk of convulsions.
2. Tachycardia: Stimulants induce sympathetic activation, leading to increased heart rate.
3. Dilated Pupils: Sympathetic nervous system stimulation causes pupil dilation (mydriasis).
4. Paranoia: Stimulant intoxication often results in psychosis, including paranoia and hallucinations.
5. Hypertension: Elevated catecholamines increase blood pressure, seen in stimulant intoxication.

Hallucinogen Intoxication

1. Seizures: Some hallucinogens (e.g., LSD) can induce seizures due to excitatory effects.
2. Tachycardia: Hallucinogens stimulate the autonomic nervous system, increasing heart rate.
3. Dilated Pupils: Similar to stimulants, hallucinogens can cause mydriasis.
4. Paranoia: Hallucinogen intoxication can result in psychosis, including paranoia.
5. Hypertension: Increased autonomic activity leads to elevated blood pressure.

Choice A rationale: Blood glucose level

A blood glucose level of 200 mg/dL is elevated, suggesting possible hyperglycemia. Clozapine, an atypical antipsychotic, can cause metabolic effects, including insulin resistance, leading to diabetes. This warrants further evaluation by the provider to determine if glucose monitoring or treatment adjustments are needed.

Choice B rationale: WBC count

A WBC count of 4,800/mm³ is low, which is concerning because clozapine can cause agranulocytosis, a severe condition where white blood cells drop significantly, increasing the risk of infection. Since the client is on clozapine, the provider must be informed to assess the need for additional lab monitoring or medication adjustments.

Choice C rationale: Temperature

A temperature of 37.8°C (100.0°F) may indicate a mild fever, which is concerning in the context of a low WBC count. Since clozapine increases infection risk due to potential agranulocytosis, this temperature should be reported to rule out an underlying infection.

Choice D rationale: Blood pressure

A blood pressure of 110/68 mm Hg is within the normal range and does not warrant immediate intervention. It is not concerning in this case.