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NORCET-11 Prelims
Mental Health Nursing
Easy

A patient is on psychiatric medications. Which medication requires routine complete blood count monitoring?

Appeared in: NORCET-11 Prelims

Explanation

  • Clozapine carries a high risk of agranulocytosis, a potentially fatal drop in white blood cells.
  • Routine CBC with differential is required: weekly for 6 months, every other week for 6 months, then every 4 weeks.
  • CBC monitoring is mandated before starting and throughout clozapine therapy.
  • No other listed psychiatric medication requires such frequent CBC monitoring.

Why Other Options Were Wrong

  • Option B: Lithium requires monitoring of serum drug levels, renal function, thyroid function, and electrolytes, but not routine CBC monitoring except at baseline or if clinically indicated.
  • Option C: Haloperidol does not require routine CBC monitoring. It is not associated with agranulocytosis as a major risk.
  • Option D: Chlorpromazine can rarely cause blood dyscrasias, but routine CBC monitoring is not mandated. Monitoring is based on clinical suspicion.

Related Visual

Comparison of monitoring requirements for clozapine, lithium, haloperidol, and chlorpromazine, highlighting the frequency and type of monitoring for each.
Clinical Relevance
  • Nursing practice connection: Use the key finding related to Routine CBC monitoring requirement for psychiatric medications to guide bedside assessment, documentation, and the next nursing action.
  • Nurses must check CBC results before administering clozapine to prevent agranulocytosis.
  • Routine monitoring helps detect neutropenia early, reducing risk of severe infection.
  • What if? If a patient on clozapine develops fever or sore throat, immediate CBC is required and clozapine may need to be stopped.
How to Approach the Question
  • Recall which psychiatric medications have unique side effects requiring special monitoring.
  • Associate clozapine with agranulocytosis and mandatory CBC checks.
  • Eliminate options that do not require routine CBC monitoring.
  • Match the monitoring protocol to the drug's risk profile.
  • Use process of elimination for medications with other monitoring needs.
Concept Tested & Keywords
  • Concept Tested: Routine CBC monitoring requirement for psychiatric medications
  • Stem keywords: psychiatric medications, routine complete blood count monitoring
  • Lead-in keywords: requires, routine, monitoring
  • Clinical cues: CBC monitoring is critical for clozapine due to agranulocytosis risk

Question ID

QgJ5Rhjfi8-Qd7HVXaUk-w

Reference Book

E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) pp. 3488-3490, 3483-3485, 9970-9972

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