A 20-kg child has been taking valproic acid Depakote for 1 week ...

[geodog55]

A 20-kg child has been taking valproic acid Depakote for 1 week to treat a seizure disorder. The child is receiving 200 mg PO twice daily. The child's parents report no improvement in sei-zure activity.
 
  The nurse will anticipate that the provider will order which change in this child's drug regimen? a. Adding another seizure medication to supplement the valproic acid
  b. Changing to phenytoin Dilantin since the valproic acid is not effective
  c. Increasing the dose of valproic acid to 300 mg PO twice daily
  d. Increasing the dose of valproic acid to 200 mg three times daily

Question 2

A patient is taking enalapril Vasotec. The nurse understands that patients taking this type of drug for heart failure need to be monitored carefully for:
 
  a. hypernatremia.
  b. hypertension.
  c. hyperkalemia.
  d. hypokalemia.

[LegendaryAnswers]

Answer to Question 1

C
Valproic acid is given initially at a dose of 5 to 15 mg/kg/day, administered in two divided doses. This child is receiving 400 mg/day, which is 10 mg/kg/day. The dosage should be increased by 5 to 10 mg/kg/day each week until optimal levels are achieved up to a maximum dose of 60 mg/kg/day. At this point, adding another AED or changing to another AED is not recommended. Increasing the dose to three times daily is not recommended.

Answer to Question 2

C
One of the principal effects of angiotensin-converting enzyme (ACE) inhibitors is hyperkalemia, which is due to decreased aldosterone release arising from blockage of angiotensin II. There is no indication that careful monitoring of sodium for increased levels is indicated. Vasotec is indi-cated for heart failure, not hypertension. The drug therapy should be monitored to ascertain its effectiveness, but hyperkalemia is the main concern. Hyperkalemia, not hypokalemia, is a concern because of the decreased aldosterone release that occurs with blockage of angiotensin II.

[geodog55]

TYSM

[raenoj]

Excellent