A patient who is taking oral contraceptives begins taking valproic acid (Depakote) for seizures. After a week of therapy with valproic acid, the patient tells the nurse that she is experiencing nausea. What will the nurse do?
a. Ask the patient if she is taking the valproic acid with food, because taking the drug on an empty stomach can cause gastrointestinal side effects.
b. Contact the provider to request an order for a blood ammonia level, because hyperammonemia can occur with valproic acid therapy.
c. Suggest that the patient perform a home pregnancy test, because valproic acid can reduce the efficacy of oral contraceptives.
d. Suspect that hepatotoxicity has occurred, because this is a common adverse effect of valproic acid.
ANS: A
Gastrointestinal effects, including nausea, vomiting, and indigestion, are common with valproic acid and can be minimized by taking the drug with food or using an enteric-coated product. Hyperammonemia can occur when valproic acid is combined with topiramate. Signs of pregnancy usually do not occur within a week, so this is less likely. Hepatotoxicity is a rare adverse effect.
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