A patient with bipolar disorder has unexpectedly become pregnant and is concerned about the possible impact of valproate on her and her baby. What can the nurse tell her?
1. "Valproate is not associated with any fetal risks."
2. "There is no problem if you stop your medications."
3. "Valproate has been associated with several significant fetal risks."
4. "If you take other medications, you can reduce the risks of valproate."
Answer: 3
Explanation: Both sodium valproate and carbamazepine have been associated with an increased risk of neural tube defects and fetal anticonvulsant syndromes. Valproate is associated with multiple fetal risks. There is a significant risk of a bipolar relapse if the patient stops taking her medications suddenly. Increased teratogenic risk is actually compounded by polypharmacy.
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