Author Question: A patient taking valproic acid (Depakote) for the management of a seizure disorder has a trough ... (Read 22 times)

imowrer · **on:** Jul 23, 2018

A patient taking valproic acid (Depakote) for the management of a seizure disorder has a trough serum drug level drawn.

Which laboratory result would prompt the nurse to ask the patient about the adequacy of the medication supply and daily dosing routines?
a. 52 mcg/mL
b. 24 mcg/mL
c. 120 mcg/mL
d. 75 mcg/mL

Question 2

A patient is going to be started on valproic acid (Depakote) for seizures and tells the nurse during the health history, I drink a six-pack of beer daily and two to three six-packs on weekends. The priority nursing action would be to

a. obtain plasma levels of valproic acid (Depakote).
b. determine other drug-to-drug interactions.
c. obtain liver function studies.
d. obtain serum creatinine levels.

Sassygurl126 · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

ANS: B
The normal Depakote level is 50 to 150 mcg/mL; a value below 50 mcg/mL indicates a subtherapeutic level, especially when a trough level (30 minutes before next dose) is drawn. The nurse should question whether compliance is an issue or perhaps a dosage adjustment is in order.
The other levels are within normal range and therefore would not be a concern.

Answer to Question 2

ANS: C
The priority nursing action for a patient with a history of chronic alcohol use would be to obtain baseline liver function tests; the patient may have an impaired liver, which may progress quickly to hepatotoxicity if he takes valproic acid.
The patient has not yet begun therapy with Depakote, therefore a level is not indicated.
The priority nursing concern is to assess the liver before beginning valproic acid therapy.
Hepatotoxicity, not nephrotoxicity, is a concern when administering valproic acid.