A client taking clozapine calls the clinic and reports fever, chills, and a sore throat. The next dose is due soon. Which instruction should the nurse provide?
1Hold the dose and obtain prompt clinical evaluation for infection and neutropenia✓ Correct answer
2Take acetaminophen for the fever and continue clozapine on the usual schedule
3Double the next clozapine dose because infection can reduce medication absorption
4Stop clozapine permanently and discard the medication without further evaluation
Explanation
Fever, chills, and sore throat may indicate infection from clozapine-associated severe neutropenia. The client needs prompt clinical assessment and ANC evaluation before another dose. Current FDA guidance no longer requires REMS enrollment, but neutropenia monitoring remains important.
Quick answer Hold the upcoming dose and arrange prompt evaluation for infection and neutropenia. Fever, chills, and sore throat are warning symptoms that require assessment before continued clozapine exposure.
Why this is correct Clozapine can markedly lower neutrophils and reduce the body's ability to fight infection. Symptoms may appear before the client knows the blood count is low, so clinical evaluation and an ANC help guide whether treatment is paused, modified, or safely continued.
Easy analogy or mental picture Neutrophils are like the first-response crew for infection. Clozapine can shrink that crew, so fever is an alarm that requires a head count; the analogy does not mean every fever is caused by neutropenia.
Memory hook Clozapine plus infection symptoms means pause the next dose and check the infection-fighting cells.
NCLEX decision rule For medications that can suppress bone marrow, connect fever, chills, sore throat, mouth ulcers, or unusual weakness with possible neutropenia. Hold the immediate dose and obtain timely clinical and laboratory guidance rather than masking symptoms.
Why the other choices are wrong Acetaminophen can hide fever while serious infection progresses. Doubling clozapine has no therapeutic basis and increases toxicity, while permanent discontinuation without evaluation can cause relapse and ignores the individualized ANC-based plan.
References
[1]
NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing
[2]
FDA: Clozapine REMS Removal and Continuing ANC MonitoringU.S. Food and Drug Administration, 2025