A nurse is caring for a client who has Wernicke-Korsakoff psychosis as a result of chronic alcohol use disorder. Which of the following interventions should the nurse anticipate?

A. A pretreatment electroencephalogram (EEG) is not typically required before starting valproate therapy. EEGs may be used in the diagnosis and management of seizure disorders, but they are not a standard part of valproate therapy initiation.

B. High serum sodium levels are not associated with toxic levels of valproate. Instead, valproate can cause hyperammonemia, especially in individuals with urea cycle disorders.

C. Thyroid function tests are not typically required specifically for valproate therapy. However, valproate may interfere with thyroid hormone levels, so thyroid function tests might be ordered if there are symptoms of thyroid dysfunction.

D. Monitoring liver function tests is essential when taking valproate because the medication can cause hepatotoxicity. Clients should have baseline liver function tests before starting valproate, followed by regular monitoring throughout treatment. If liver function test results indicate liver damage, the healthcare provider may adjust the dosage or discontinue the medication. Therefore, this is the correct instruction to provide to the client starting valproate therapy.

Fluid excess, also known as fluid overload or hypervolemia, occurs when there is an excessive volume of fluid in the body. The nurse should assess for signs and symptoms of fluid excess, which include the following:

A. Bounding pulse: A bounding pulse, or a pulse that feels unusually strong and forceful, can be a sign of fluid excess. Increased blood volume leads to increased cardiac output, which can manifest as a bounding pulse.

B. Urine-specific gravity greater than 1.030: Urine-specific gravity greater than 1.030 typically indicates concentrated urine and is more indicative of dehydration rather than fluid excess.

C. Pitting edema: Pitting edema occurs when pressure is applied to the skin, resulting in an indentation or "pit" that persists after the pressure is released. It is a classic sign of fluid excess, indicating fluid accumulation in the interstitial spaces.

D. Swelling at the IV site: Swelling at the IV site may indicate infiltration or phlebitis rather than fluid excess. While fluid excess can lead to generalized swelling, swelling specifically at the IV site may suggest a local issue related to the IV infusion.

E. Crackles upon auscultation: Crackles, also known as rales, are abnormal lung sounds heard upon auscultation and are indicative of fluid accumulation in the lungs, which can occur with fluid excess. Crackles are typically heard in the bases of the lungs and may indicate pulmonary edema.