A nurse is reinforcing teaching with a client who has a new prescription for clozapine. Which of the following adverse effects should the nurse include in the teaching?

Choice A rationale Hyperreflexia, or overactive reflexes, is not a common adverse effect associated with clozapine. This symptom is more frequently seen in conditions like serotonin syndrome or during certain types of neurological impairment. Clozapine is a second-generation antipsychotic that primarily affects dopamine and serotonin receptors. While it has a complex side effect profile including potential seizures, it does not typically cause the specific neuromuscular excitability characterized by hyperreflexia or increased deep tendon reflex responses. Choice B rationale Tachycardia is a frequently reported adverse effect of clozapine, often occurring during the initial titration phase of the medication. This increase in heart rate, defined as a resting rate above 100 beats per minute, is often related to the drug's anticholinergic effects or its impact on the autonomic nervous system. Clients must be monitored closely for persistent tachycardia, as it could also be a sign of clozapine-induced myocarditis, a rare but serious inflammatory heart condition. Choice C rationale Wheezing is a respiratory symptom indicative of airway constriction or inflammation and is not a documented side effect of clozapine. Clozapine primarily targets the central nervous system and does not typically trigger bronchial smooth muscle contraction or allergic pulmonary reactions. If a patient on clozapine experiences wheezing, the nurse should investigate other causes such as asthma, anaphylaxis, or respiratory infection rather than attributing the finding to the pharmacological properties of this specific antipsychotic. Choice D rationale Rhinitis, or inflammation of the nasal mucous membranes, is not a standard side effect associated with clozapine therapy. Clozapine more commonly causes hypersalivation, especially at night, which can lead to drooling. This occurs due to the drug's complex interaction with muscarinic and adrenergic receptors. While upper respiratory symptoms are common in the general population, they do not have a direct pharmacological link to clozapine's mechanism of action or its known adverse reaction profile.