A nurse is preparing to administer total parental nutrition (TPN) 1800 mL to infuse over 24 hr. The nurse should set the IV pump to deliver how many mL/hr?

(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. "It doesn't really matter what time you take your medications as long as you don't skip any doses": This statement is incorrect because adherence to the prescribed dosing schedule is crucial for the effectiveness of medications. Inconsistent timing of doses can lead to suboptimal therapeutic outcomes or potential adverse effects.

B. "Let's work together to devise a time schedule that is convenient for you on a daily basis": This is the most appropriate instruction. Collaborating with the client to establish a medication schedule that aligns with their daily routine increases the likelihood of adherence. It promotes patient autonomy and empowers the client to take ownership of their medication regimen.

C. "You really shouldn't change the schedule we established here in the facility": While maintaining consistency in medication administration times is important, rigidly adhering to a schedule established during the facility stay may not always be feasible or practical for the client at home. Flexibility in adjusting the schedule to fit the client's lifestyle is essential for long-term adherence.

D. "We'll have to talk to your provider about switching to an alternative schedule": Switching to an alternative schedule should be considered only if the current schedule is not feasible for the client or if it compromises medication adherence. However, exploring options for adapting the existing schedule to better suit the client's needs should be attempted first before considering a switch.