A nurse is reviewing the medical record of a male client who has schizophrenia and is taking clozapine. Which of the following findings should the nurse identify as a contraindication to the administration of clozapine?

Rationale: A. This indicates mild anemia, but it is not a contraindication to clozapine therapy. Clozapine’s primary serious hematologic concern is neutropenia/agranulocytosis, not low hemoglobin. While anemia should be monitored, it does not require holding the medication. B. A heart rate of 58/min represents mild bradycardia, which may or may not be clinically significant depending on symptoms. Clozapine can affect cardiovascular function (e.g., myocarditis, orthostatic hypotension), but bradycardia alone is not a contraindication. C. Clozapine is strongly associated with severe neutropenia and agranulocytosis, which can be life-threatening due to infection risk. An ANC below 1,500/mm³ is generally a contraindication or requires immediate interruption of therapy depending on severity and guidelines. An ANC of 1,300/mm³ indicates significant neutropenia, so the medication should be withheld and the provider notified. D. Clozapine can cause metabolic side effects, including hyperglycemia and weight gain. A mildly elevated fasting glucose is a known adverse effect but is not a contraindication to therapy. It should be monitored and managed but does not require stopping the medication.