Which data should the nurse assess for the client with a seizure disorder who is taking valproate (Depakote)?
Creatinine and BUN.
White blood cell count.
Red blood cell count.
Liver enzymes.
The Correct Answer is D
Choice A rationale
Creatinine (normal range: 0.6-1.2 mg/dL) and Blood Urea Nitrogen (BUN) (normal range: 7-20 mg/dL) are indicators of kidney function. While kidney function is important, valproate is primarily metabolized by the liver, making liver function monitoring more critical than routine renal function assessment for this medication.
Choice B rationale
White blood cell count (normal range: 4,000-11,000 cells/µL) measures components of the immune system. Although some anticonvulsants can affect blood counts, valproate's primary adverse effect profile does not typically involve significant or common alterations in white blood cell count requiring routine monitoring.
Choice C rationale
Red blood cell count (normal range: 4.2-5.4 million cells/µL for women; 4.7-6.1 million cells/µL for men) measures oxygen-carrying capacity. While certain medications can cause anemia, valproate is not commonly associated with significant hematological toxicities involving red blood cells that necessitate routine monitoring.
Choice D rationale
Liver enzymes, such as ALT (normal range: 7-56 U/L) and AST (normal range: 10-40 U/L), are crucial to assess for a client taking valproate. This medication is hepatically metabolized and can cause dose-related transient elevations or, rarely, severe, potentially fatal hepatotoxicity, necessitating regular monitoring of liver function.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Active tuberculosis is primarily transmitted via airborne particles containing Mycobacterium tuberculosis. Therefore, isolating the client in a private room equipped with negative pressure ventilation is crucial. This system ensures that air from the room is exhausted directly outside or through a high-efficiency particulate air (HEPA) filter, preventing the dissemination of airborne pathogens to other areas and protecting healthcare workers and other clients from exposure.
Choice B rationale
Assigning a client with active tuberculosis to a room with clients requiring droplet precautions is inappropriate. Droplet precautions are for larger respiratory droplets that typically travel short distances, whereas tuberculosis involves smaller airborne nuclei that can remain suspended in the air and travel greater distances. This placement would significantly increase the risk of cross-contamination and disease transmission to other susceptible individuals within the healthcare environment.
Choice C rationale
While masks are essential for airborne precautions, routine use of gowns and gloves for staff and visitors is generally not required for tuberculosis unless direct contact with respiratory secretions or contaminated items is anticipated. The primary mode of transmission is airborne, making respiratory protection the paramount intervention. Over-gowning and gloving unnecessarily consume resources and do not significantly enhance protection against airborne transmission.
Choice D rationale
Modifying the protocol for donning and removing personal protective equipment (PPE) before entering or leaving the client's room is unsafe and increases the risk of contamination. Strict adherence to established PPE protocols, including proper hand hygiene and the correct sequence for donning and doffing, is critical to prevent self-contamination and the spread of pathogens. Any deviation from these protocols compromises safety and infection control efficacy.
Correct Answer is D
Explanation
Choice A rationale
Teaching about reasons for blood tests is generally part of patient education but is not the primary action for bacteriologic testing for tuberculosis. While blood tests like interferon-gamma release assays (IGRAs) can diagnose latent TB, sputum cultures are essential for confirming active disease and determining drug susceptibility.
Choice B rationale
Scheduling a chest X-ray is a diagnostic step for tuberculosis but does not directly address the order for bacteriologic testing. A chest X-ray can reveal pulmonary infiltrates or cavitations suggestive of TB, but definitive diagnosis of active disease and identification of the causative organism requires microbiological confirmation from sputum.
Choice C rationale
Instructing the patient to collect several separate sputum specimens today is incorrect and would not yield optimal diagnostic results. For accurate bacteriologic diagnosis of active tuberculosis, guidelines recommend collecting early morning sputum specimens on separate, consecutive days to increase the likelihood of detecting mycobacteria.
Choice D rationale
Teaching the patient about providing specimens for 3 consecutive days is the scientifically correct action. Mycobacterial shedding can be intermittent, so collecting three consecutive early morning sputum specimens maximizes the chance of isolating *Mycobacterium tuberculosis* on culture and performing acid-fast bacilli (AFB) smear microscopy, confirming active disease.
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