Drug Therapy for Bipolar Disorder (ATI Neuro Part 2): valproic acid ( Depakene and Depakote ) Practice Questions

The most serious adverse effect associated with valproic acid is: A. Fatal hepatic failure B. Gingival hyperplasia C. Drowsiness D. Mood disorder E. Dementia

A. Fatal hepatic failure

A nurse is caring for a client who has a new prescription for valproic acid. The nurse should instruct the client that while taking this medication, he will need to have which of the following lab tests completed periodically? (Select all that apply.) a. Thrombocyte count b. Hematocrit c. Amylase d. Liver function test e. Potassium

ANSWER: a, c, d Rationale: a. CORRECT: Treatment with valproic acid can result in thrombocytopenia. Therefore, the client's thrombocyte count should be monitored periodically. b. INCORRECT: Treatment with valproic acid is not known to have an effect on a client's hematocrit c. CORRECT: Treatment with valproic acid can result in pancreatitis. Therefore, the client's amylase should be monitored periodically. d. CORRECT: Treatment with valproic acid can result in hepatotoxicity. Therefore, the client's liver function should be monitored periodically. e. INCORRECT: Treatment with valproic acid is not known to have an effect on a client's potassium.

A nurse is teaching a client who has a new prescription for valproic acid to treat a seizure disorder. The nurse should instruct the client to monitor for which of the following adverse effects. (Select all that apply.) A. Hirsutism B. Drowsiness C. Headache D. Ataxia E. Rash

B. Drowsiness C. Headache E. Rash Rationale: A. Valproic acid is more likely to cause hair loss rather than hirsutism, or excessive hair growth. B. Clients taking valproic acid should report CNS depressant effects, such as sedation or drowsiness, because these adverse effects can indicate the need for a reduction in dose. C. Valproic acid can cause headache, along with other CNS adverse effects, such as sleep disturbances. D. Ataxia is an adverse effect of phenytoin and carbamazepine, which are drugs used to treat seizure disorders. E. Skin rash is an adverse effect of valproic acid and other antiepileptic drugs.

A nurse is reviewing the medical record of a client who has a newly diagnosed seizure disorder and a new prescription for valproic acid and phenytoin. The nurse should identify that which of the following can occur as a result of an interaction between these drugs? A. Hyperammonemia B. Phenytoin toxicity C. Hypertension D. Peptic ulcer disease

B. Phenytoin toxicity Rationale: A. Hyperammonemia is unlikely to result from a drug interaction between valproic acid and phenytoin. Taking valproic acid with topiramate, however, can increase the risk of excess ammonia in the blood. B. Valproic acid can cause an increase in phenytoin blood levels, resulting in phenytoin toxicity. The nurse should monitor serum phenytoin levels and notify the provider if levels begin to exceed the therapeutic range. C. Hypertension is unlikely to result from a drug interaction between valproic acid and phenytoin. Phenytoin does have CNS depressive effects and can cause hypotension, especially when administered via IV. D. Peptic ulcer disease is unlikely to result from a drug interaction between valproic acid and phenytoin. Taking cimetidine with phenytoin, however, can increase phenytoin levels.

A nurse is caring for a client who has a new prescription for valproic acid to treat a seizure disorder. The nurse should instruct the client to monitor for which of the following adverse effects? A. Hirsutism B. Depression C. Jaundice D. Gum irritation

C. Jaundice Rationale: A. Valproic acid is unlikely to cause hirsutism, or excessive hair growth, but it can cause transient hair loss. B. Valproic acid is unlikely to cause depression, but it can cause aggression. C. Valproic acid can cause hepatic toxicity, characterized by jaundice, abdominal pain, and nausea. Clients taking the drug should report these manifestations, and the nurse should monitor liver function studies prior to treatment and periodically during therapy. D. Valproic acid is unlikely to cause gum irritation. Phenytoin can cause gingival hyperplasia.

Which AED is related to an increased incidence of neural tube defects in the fetus of mothers who received the drug during the first trimester of pregnancy? A. Diazepam B. Phenytoin C. Valproic acid D. Gabapentin E. Topiramate

C. Valproic acid

The nurse is providing education for a 12-year-old patient with partial seizures currently prescribed valproic acid (Depakene). The nurse will teach the patient and the parents to immediately report which symptom? a. Increasing or severe abdominal pain b. Decreased or foul taste in the mouth c. Pruritus and dry skin d. Bone and joint pain

a. Increasing or severe abdominal pain Valproic acid may cause life- threatening pancreatitis, and any severe or increas- ing abdominal pain should be reported immediately.

Which of the following medications may be used to treat partial seizures? (select all that apply) a. Phenytoin (Dilantin) b. Valproic Acid (Depakene) c. Diazepam (Valium) d. Carbamazepine (Tegretol) e. Ethosuximide (Zarontin)

a. Phenytoin (Dilantin) b. Valproic Acid (Depakene) d. Carbamazepine (Tegretol) The phenytoin-like drugs in- cluding phenytoin (Dilantin), valproic acid (Depakene), and carbamazepine (Tegretol) are used to treat partial sei- zures. Options c and e are incorrect. Diazepam (Valium) is a benzodiazepine that is used to treat tonic-clonic sei- zures and status epilepticus. Ethosuximide (Zarontin) is used in the control of generalized seizures such as absence seizures.

A nurse is providing discharge teaching to a client who is prescribed valproic acid (Depakene) orally twice daily. Which statement by the client warrants further teaching? a. "I will take this medication with food to prevent stomach upset." b. "I will not mix this liquid medication with any carbonated drinks." c. "I can chew the extended-release tablets, so I can swallow it easier." d. "I can open the capsules and sprinkle the medication on soft food."

c. "I can chew the extended-release tablets, so I can swallow it easier." It is important that the patient understands proper medication administration of antiseizure drugs for maximum efficacy and minimizing adverse effects. Valproic acid is a gastrointestinal (GI) irritant, so it should be taken with food to decrease GI upset. The nurse should advise the patient not to chew extended-release tablets, because mouth soreness will occur. Valproic acid syrup should not be mixed with carbonated beverages, because it will trigger immediate release of the drug, which causes severe mouth and throat irritation. If the patient cannot swallow the capsule form of the medication, the patient can break the capsules open and sprinkle the medication on soft foods.