What is an important consideration when educating a patient about taking Sertraline (Zoloft), an SSRI?

Choice A reason: Asthma is not a contraindication to clozapine use. While respiratory conditions require monitoring, they do not prevent clozapine therapy.

Choice B reason: A fasting blood glucose of 120 mg/dL indicates impaired fasting glucose but is not a contraindication. Clozapine can cause metabolic side effects, but this value alone does not prohibit use.

Choice C reason: Clozapine carries a risk of agranulocytosis, a severe reduction in white blood cells. A WBC count of 3.3/mm³ is dangerously low and contraindicates clozapine therapy due to risk of life-threatening infection.

Choice D reason: Migraines are not a contraindication to clozapine. They are unrelated to the drug’s hematologic risks.

The client presents with acute physical symptoms such as tachycardia, nausea, palpitations, clammy hands, and restlessness, which are consistent with severe panic level anxiety. The diagnostic score of 34 on the generalized anxiety disorder scale indicates significant impairment. The client’s statements reflect overwhelming fear and inability to accept negative test results, showing distorted perception typical of panic. The history of anxiety disorder supports recurrence of severe anxiety episodes. Therefore, severe panic level anxiety is the most accurate condition.

Rationale for the two correct actions

Provide reassurance and remain with the client:This action reduces feelings of isolation and fear, helping the client regain a sense of safety during panic.

Encourage use of relaxation and coping techniques:Teaching breathing exercises or guided imagery helps reduce sympathetic nervous system activation and promotes long-term management of anxiety.

Rationale for parameters to monitor

Reality orientation:Monitoring ensures the client maintains awareness of person, place, and time, which can be impaired during severe panic episodes.

Self-injurious behavior:Although the client denies harm, anxiety can escalate, so monitoring ensures safety and early intervention if risk develops.

Rationale for incorrect conditions

Borderline personality disorder:No evidence of unstable relationships, impulsivity, or identity disturbance.

Bipolar disorder:No history of manic or depressive episodes.

Major depressive disorder:Client is restless and anxious, not withdrawn or showing persistent sadness with vegetative symptoms.

Post-traumatic stress disorder:No trauma history or flashbacks reported.

Rationale for incorrect actions to take

Settle the client in a quiet environment:While helpful, it does not directly address panic symptoms or build coping skills.

Secure a written safety contract:Not appropriate since the client denies suicidal ideation and the issue is acute panic, not self-harm risk.

Establish therapeutic trust:Important but not the immediate priority during a panic episode compared to reassurance and coping strategies.

Rationale for incorrect parameters to monitor

Loss or increase in appetite:More relevant to depressive disorders, not acute panic.

Increased sleeping:Associated with depression or fatigue, not panic.

Neglect of self-care activities:Seen in depressive or psychotic conditions, not in acute anxiety where hyperarousal dominates.