A client was switched from lurasidone to clozapine 2 months ago. His most recent absolute neutrophil count was 1654/mcL. How often should the psychiatric mental health nurse practitioner order complete blood counts for the client?

Choice A reason: Monitoring every 2 weeks is only appropriate for patients who have completed 6 to 12 months of clozapine therapy with stable absolute neutrophil counts (ANC). Since this client has only been on the medication for 2 months, they are still within the initial high-risk period for agranulocytosis and do not qualify for biweekly monitoring. Choice B reason: Monthly monitoring is reserved for patients who have been on clozapine for over 1 year with consistently normal ANC results. This client is far too early in his treatment course for monthly labs. Clozapine requires the most frequent monitoring during the first 6 months of therapy to ensure patient safety. Choice C reason: Daily complete blood counts (CBC) are not required for a stable ANC of 1654/mcL. Daily monitoring would only be indicated if the ANC dropped significantly below 1000/mcL (severe neutropenia), necessitating the discontinuation of clozapine and close hematological supervision to manage the risk of life-threatening infection. Choice D reason: For the first 6 months of clozapine treatment, the standard protocol is weekly CBC and ANC monitoring. An ANC of 1654/mcL is within the normal range (≥ 1500/mcL). Because the client is only in his second month of therapy, weekly testing must continue to satisfy the Risk Evaluation and Mitigation Strategy (REMS) requirements.