A nurse is teaching a client who has been newly diagnosed with epilepsy about the use of anticonvulsant medications. Which of the following statements by the client indicates a need for further teaching? (Select all that apply.)

- **"I should stop taking these medications if I have a rash or fever."** This statement is incorrect and indicates a need for further teaching because the client should not stop taking anticonvulsant medications abruptly, as this can cause withdrawal symptoms and increase the risk of seizures¹². The client should contact their healthcare provider if they have a rash or fever, as these could be signs of an allergic reaction or infection, but they should not stop the medication without medical advice¹².

- **"I should have my blood levels checked regularly to make sure I am taking the right dose."** This statement is correct for some anticonvulsant medications, such as phenytoin, carbamazepine, and valproate, but not for others, such as levetiracetam, lamotrigine, and gabapentin¹³. The client should ask their healthcare provider which medications require blood level monitoring and how often they need to have it done¹³.

The other statements by the client are correct and do not indicate a need for further teaching:

- **"I should avoid drinking alcohol while taking these medications."** This statement is correct because alcohol can interact with anticonvulsant medications and increase their side effects, such as drowsiness, dizziness, and impaired coordination¹². Alcohol can also lower the seizure threshold and trigger seizures in some people¹².

- **"I should take these medications at the same time every day."** This statement is correct because taking anticonvulsant medications at the same time every day helps maintain a steady level of the drug in the blood and prevent seizures¹². The client should follow the prescribed schedule and dosage of their medication and not miss or skip any doses¹².

- **"I should not drive or operate heavy machinery until I know how these medications affect me."** This statement is correct because anticonvulsant medications can cause side effects that impair the client's ability to drive or operate heavy machinery, such as blurred vision, confusion, fatigue, and poor

Valproic acid can interact with warfarin and increase the risk of bleeding by inhibiting the metabolism of warfarin and displacing it from plasma protein binding sites¹. The nurse should monitor the client's international normalized ratio (INR) and prothrombin time (PT) and adjust the warfarin dose accordingly.

Choice B. Metformin is wrong because valproic acid does not have a significant interaction with metformin. Metformin is an oral antidiabetic drug that lowers blood glucose levels by decreasing hepatic glucose production and increasing insulin sensitivity².

Choice C. Ibuprofen is wrong because valproic acid does not have a significant interaction with ibuprofen. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that reduces inflammation, pain, and fever by inhibiting cyclooxygenase enzymes².

Choice D. Levothyroxine is wrong because valproic acid does not have a significant interaction with levothyroxine. Levothyroxine is a synthetic thyroid hormone that replaces the deficient endogenous hormone in hypothyroidism².