Practice Question
A nurse is planning care for a patient who has seizure disorder and a new prescription for valproic acid. Which of the following laboratory values should the nurse plan to monitor? (Select All that Apply.)
Answer Choices:
Correct Answer:
Platelet count.
Rationale:
Platelet count
💎 Valproic acid can cause thrombocytopenia, so baseline and periodic platelet monitoring is essential to catch early declines before bleeding occurs.
💎 Watch for clinical signs of low platelets—easy bruising, petechiae, mucosal bleeding—because they often precede severe drops on labs.
💎 The risk increases with higher serum valproate levels and in older adults, making dose-related surveillance particularly important.
💎 If platelets fall or bleeding develops, the prescriber may reduce the dose or discontinue the drug to prevent hemorrhagic complications.
💎 Document trends (not just single values) because a progressive downward trajectory can signal impending coagulopathy even before hitting critical thresholds.
Liver function tests (LFTs)
💎 Valproic acid is hepatotoxic, so obtain baseline AST/ALT, bilirubin, and INR, then monitor frequently during the first 6 months, when risk is highest.
💎 Educate patients to report jaundice, dark urine, RUQ pain, anorexia, malaise, which can accompany drug‑induced liver injury (DILI).
💎 Children (especially <2 years) and those with mitochondrial disorders have greater vulnerability; for them, closer LFT surveillance is warranted.
💎 Rising transaminases or bilirubin should prompt dose reassessment or drug discontinuation to avert acute liver failure.
💎 Consistent tracking supports early detection and protects against life‑threatening hepatic complications while maintaining seizure control.
Ammonia levels
💎 Valproate can precipitate hyperammonemia with or without LFT elevations, leading to encephalopathy (confusion, lethargy, vomiting, ataxia).
💎 Check serum ammonia at baseline in high‑risk patients and anytime mental status changes occur to avoid missing valproate‑induced hyperammonemic encephalopathy.
💎 Risk increases with polytherapy (e.g., topiramate), carnitine deficiency, or urea‑cycle disorders, so monitoring is risk‑stratified and ongoing.
💎 If ammonia is elevated, management may include dose reduction/cessation and L‑carnitine per provider orders to reverse neurotoxicity.
💎 Prompt recognition and treatment of hyperammonemia preserve neurologic function while enabling safe continuation of antiepileptic therapy when appropriate.
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This question is from Custom: Pharm NUR 300G-02-Smith-Spr 25 Final which contains 78 questions.
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Question Details
- Category: RN Nursing Exam(s)
- Subcategory: ATI Exam(s)
- Domain: RN ATI Pharmacology
- Answer Choices: 5