A patient diagnosed with schizophrenia has auditory hallucinations, delusions of grandeur, poor personal hygiene, and threatening behavior. Which assessment finding would the nurse regard as a negative symptom of schizophrenia?

Choice A reason: Blood glucose is not directly affected by valproic acid, which stabilizes mood via GABA enhancement and sodium channel inhibition. Monitoring glucose is irrelevant, as valproic acid’s primary risks involve hepatic and hematologic toxicity, not metabolic glucose dysregulation.

Choice B reason: Urinalysis is not a priority for valproic acid, which primarily risks hepatotoxicity and thrombocytopenia. It enhances GABA and inhibits sodium channels, with no significant renal effects requiring routine urine monitoring, unlike drugs affecting kidney function.

Choice C reason: Weight assessment is relevant for valproic acid due to potential weight gain, but it is not the priority. Hepatotoxicity, driven by valproic acid’s metabolism in the liver, poses a greater risk, necessitating liver function tests to monitor for severe hepatic damage.

Choice D reason: Valproic acid, metabolized by the liver, can cause hepatotoxicity by disrupting mitochondrial function and fatty acid metabolism. Liver function tests monitor transaminases and bilirubin to detect early hepatic damage, critical before initiating treatment to ensure safe use in bipolar disorder.

Choice A reason: Phenelzine, an MAOI, requires avoiding tyramine-rich foods, not selenium-rich foods. Tyramine interacts with MAOIs, causing hypertensive crises due to norepinephrine surges in the synaptic cleft. Selenium has no specific interaction with MAOIs, making this choice irrelevant to safe medication management.

Choice B reason: Phenelzine inhibits monoamine oxidase, increasing serotonin and norepinephrine, and interacts dangerously with many over-the-counter medications like pseudoephedrine, causing hypertensive crises. Consulting a pharmacist ensures safe choices, preventing adverse reactions due to altered neurotransmitter metabolism, reflecting effective understanding of MAOI risks.

Choice C reason: Monitoring sodium and weight is unrelated to phenelzine’s mechanism or side effects. MAOIs primarily affect monoamine neurotransmitters, not electrolytes or fluid balance. This behavior does not address the critical dietary or drug interaction precautions necessary for safe MAOI use.

Choice D reason: Support stockings and leg elevation address circulatory issues, not phenelzine’s risks. MAOIs increase monoamine levels, risking hypertensive crises with certain foods or drugs, not venous stasis. This behavior does not reflect understanding of phenelzine’s neurochemical interactions or safety requirements.