A nurse is reviewing the medication history of a client who has epilepsy and is taking valproic acid. The nurse notes that the client is also taking warfarin for atrial fibrillation. What is the most appropriate action for the nurse to take?

This is because anticonvulsants are essential for preventing seizures, which can be harmful for both the mother and the baby¹. Stopping or changing anticonvulsants without medical supervision can increase the risk of seizure recurrence or withdrawal symptoms¹. The doctor can monitor the blood levels of anticonvulsants and adjust the dose if needed, as well as prescribe folic acid supplements to reduce the risk of neural tube defects¹².

Choice A is wrong because advising the client to stop taking their anticonvulsants as soon as they find out that they are pregnant is not appropriate. As mentioned above, stopping anticonvulsants abruptly can cause seizures or withdrawal symptoms, which can be dangerous for both the mother and the baby¹. The client should not stop taking their anticonvulsants without consulting their doctor, who can weigh the benefits and risks of continuing or discontinuing the medication¹.

Choice C is wrong because advising the client to switch to a different type of anticonvulsant that is safer for their baby is not appropriate. There is no single anticonvulsant that is safe for all types of seizures and all stages of pregnancy². Some anticonvulsants may have a lower risk of teratogenicity than others, but they may also have different efficacy and side effects². The choice of anticonvulsant depends on several factors, such as the type and frequency of seizures, the previous response to medication, the presence of comorbidities, and the potential interactions with other drugs². The client should not switch to a different anticonvulsant without consulting their doctor, who can determine the best option for their individual case².

Choice D is wrong because advising the client to reduce their dose of anticonvulsants gradually until they deliver their baby is not appropriate. Reducing the dose of anticonvulsants can increase the risk of seizure recurrence, which can be harmful for both the mother and the baby¹. The dose of anticonvulsants should be based on the blood levels and clinical response of the client, not on a fixed schedule¹. The client should not reduce their dose of anticonvulsants without consulting their doctor, who can monitor their condition and adjust the dose if needed¹.

This statement indicates a need for further teaching because phenytoin and phenobarbital are not effective for treating absence seizures, which are a type of generalized onset seizure that cause brief lapses in awareness, such as blank staring¹. Phenytoin and phenobarbital are narrow-spectrum anticonvulsants that are mainly used for focal seizures, which begin in one area of the brain². Taking these medications for absence seizures may worsen the condition or cause adverse effects.

The other statements are correct and do not indicate a need for further teaching.

Choice A is correct because carbamazepine and valproic acid are both effective for treating partial seizures, which are a type of focal seizure that may or may not affect awareness².

Choice B is correct because phenobarbital and lamotrigine are both effective for treating generalized tonic-clonic seizures, which are a type of generalized onset seizure that cause muscle stiffness and jerking movements².

Choice D is correct because valproic acid and levetiracetam are both effective for treating myoclonic seizures, which are a type of generalized onset seizure that cause brief jerking movements². Choice E is correct because lamotrigine and topiramate are both effective for treating atonic seizures, which are a type of generalized onset seizure that cause sudden loss of muscle tone².