Which monitoring plan should the nurse reinforce for this client who is beginning olanzapine therapy?

1 Obtain weekly complete blood counts and stop monitoring after the first month.
2 Track weight and obtain fasting glucose and lipid testing at baseline and periodically. ✓ Correct answer
3 Monitor thyroid hormone and calcium levels because metabolic screening is unnecessary.
4 Limit follow-up to an electrocardiogram unless involuntary movements develop.

Explanation

Olanzapine can cause clinically important weight gain, hyperglycemia, and dyslipidemia. Weight should be monitored regularly, with fasting glucose and lipid assessment at the start of therapy and periodically thereafter, especially in a client with elevated BMI and a family history of diabetes.

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In-depth explanation

Quick answer
Monitor weight, glucose, and lipids.

Why this is correct
Olanzapine is associated with hyperglycemia, dyslipidemia, and weight gain. This client's BMI and family history make a baseline-and-follow-up metabolic plan especially important.

Easy analogy or mental picture
Think of a three-gauge metabolic dashboard: scale, glucose, and lipids.

Memory hook
Olanzapine: weight, sugar, fats.

NCLEX decision rule
Match surveillance to the medication's common high-impact adverse effects and the client's baseline risk factors.

Why the other choices are wrong
Routine weekly CBC, isolated thyroid or calcium testing, and ECG-only follow-up do not address olanzapine's principal metabolic risks.

References

1DailyMed: OlanzapineWeight, fasting glucose, and lipid monitoring

Clinical scenario

Scenario A 36-year-old female with bipolar I disorder is starting olanzapine 10 mg PO HS. Baseline BMI 28 and a family history of type 2 diabetes. The nurse provides teaching about long-term safety monitoring.

Key concepts

Metabolic syndrome — Cluster of central obesity, dyslipidemia, insulin resistance, and hypertension; atypical antipsychotics (especially olanzapine and clozapine) markedly increase risk.
ADA monitoring schedule — American Diabetes Association/APA consensus protocol for tracking weight, glucose, and lipids in clients on atypical antipsychotics.
Atypical antipsychotic — Second-generation antipsychotic with serotonin-dopamine receptor blockade and lower EPS risk than typical (first-generation) agents.

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For study reference only. Always follow current clinical guidelines and your institution’s protocols.

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Which monitoring plan should the nurse reinforce for this client who is beginning olanzapine therapy?

In-depth explanation

Clinical scenario

Key concepts

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