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.

Tardive dyskinesia (TD) is a potential adverse effect associated with long-term use of antipsychotic medications like haloperidol. It manifests as involuntary, repetitive movements, primarily involving the face, mouth, and tongue. The nurse should suspect tardive dyskinesia when observing the following manifestations:

A. Involuntary pelvic rocking and hip thrusting movements: These movements are characteristic of tardive dyskinesia and indicate abnormal involuntary motor activity.

B. Urinary retention and constipation: These are not typical manifestations of tardive dyskinesia. Urinary retention and constipation can be side effects of anticholinergic medications but are not associated with tardive dyskinesia.

C. Fine hand tremors and pill rolling: These manifestations are more characteristic of parkinsonism, which can be a side effect of antipsychotic medications but is distinct from tardive dyskinesia.

D. Tongue thrusting and lip smacking: These are classic manifestations of tardive dyskinesia and indicate abnormal involuntary movements of the tongue and lips.

E. Facial grimacing and eye blinking: These are also common manifestations of tardive dyskinesia, involving involuntary movements of the face, including grimacing and blinking of the eyes.