A nurse is preparing to administer midazolam 0.2 mg/kg via IV bolus now. The client weighs 220 lb. How many mg should the nurse administer?

(Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

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.

A. Clamping the catheter: Clamping the catheter may interrupt the flow of fluids or medications, which could worsen the client's condition. This action is not appropriate as the first intervention.

B. Initiate oxygen therapy: Acute shortness of breath is a critical symptom that requires immediate intervention to ensure adequate oxygenation. Initiating oxygen therapy is the priority action to improve the client's oxygenation status while further assessment and interventions are conducted.

C. Auscultate breath sounds: Assessing breath sounds is an essential component of the assessment for a client experiencing shortness of breath. However, in this scenario, the priority is to ensure the client's oxygenation needs are met by initiating oxygen therapy first.

D. Position the client in left lateral Trendelenburg: Positioning the client in left lateral Trendelenburg may help optimize oxygenation by improving blood flow and ventilation-perfusion matching. However, this action is not the priority compared to initiating oxygen therapy, which directly addresses the client's respiratory distress.