A nurse is reviewing the medical record of a client who has a prescription for clozapine. Which of the following findings is an adverse effect of clozapine?

Introduction: Clozapine is an atypical antipsychotic reserved for treatment-resistant schizophrenia due to its potentially lethal hematologic side effects. It requires mandatory hematologic monitoring of the Absolute Neutrophil Count (ANC) to detect life-threatening bone marrow suppression before the client develops overwhelming systemic infections or sepsis. A. Hypertension is not a common adverse effect associated with clozapine therapy. On the contrary, clozapine frequently causes orthostatic hypotension due to its alpha-1 adrenergic blockade. Clients are typically monitored for significant drops in blood pressure, especially during the initial titration phase of the medication to prevent falls or syncope. B. Clozapine is more likely to cause tachycardia rather than bradycardia. The tachycardia is often a compensatory mechanism for peripheral vasodilation or a direct effect of the drug's anticholinergic properties. Bradycardia is an atypical finding and is not a recognized hallmark adverse effect of this specific antipsychotic medication. C. Hypocalcemia is not a recognized side effect of clozapine. Clozapine affects neurotransmitters like dopamine and serotonin rather than electrolyte balance or parathyroid function. Adverse metabolic effects of clozapine are more commonly related to significant weight gain, dyslipidemia, and the development of type 2 diabetes mellitus or hyperglycemia. D. Neutropenia, which can progress to agranulocytosis, is the most severe adverse effect of clozapine. Agranulocytosis involves a dangerously low white blood cell count, making the client highly susceptible to infection. Because of this risk, clients must participate in a national registry and undergo frequent, mandatory blood testing.