# A nurse is teaching a client who is starting olanzapine. Which set of follow-up monitoring parameters should the nurse emphasize?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391728&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A nurse is teaching a client who is starting olanzapine. Which set of follow-up monitoring parameters should the nurse emphasize?

## Option

1. ECG at baseline, then every 3 months, and serum potassium and magnesium quarterly
2. Weight/BMI, fasting glucose, and lipid panel at baseline, 12 weeks, and at least yearly **✔ Correct answer**
3. Thyroid panel (TSH, T4) and serum calcium at baseline, then every 6 months
4. CBC with differential at baseline, then weekly for 18 weeks, then monthly thereafter

**Correct answer: 2**

## Explanation

Correct (2): Olanzapine carries the highest metabolic risk among atypical antipsychotics — significant weight gain, new-onset type 2 diabetes, and dyslipidemia. The ADA/APA consensus monitoring schedule includes weight/BMI, waist circumference, fasting glucose, and fasting lipids at baseline, 12 weeks, and at least annually, plus blood pressure. (1) QT prolongation is less concerning with olanzapine than with ziprasidone; ECG is not the primary monitor. (3) Coagulation tests are unrelated. (4) Thyroid is not the priority metabolic concern.

## In-depth explanation

Memory Tip Highest metabolic risk: Olanzapine + Clozapine. Lowest: Aripiprazole + Lurasidone. Mid: Risperidone, Quetiapine. Clinical Practice Guide Apply the ADA/APA schedule for ANY atypical antipsychotic, even at low doses or short duration.

## 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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