In which client would a prescription of valproic acid for seizure disorder be contraindicated?

A patient with hypertension

A patient with diabetes

A patient with asthma

A pregnant patient

Answer and Explanation

The Correct Answer is D

A. A patient with hypertension:
Valproic acid is not contraindicated in patients with hypertension. While it is important to monitor for potential side effects, including those that may affect the liver or blood pressure, hypertension alone does not directly impact the safety or efficacy of valproic acid. Therefore, it is generally considered safe to prescribe in patients with well-controlled hypertension.

B. A patient with diabetes:
Valproic acid is also not contraindicated in patients with diabetes. While it is important to monitor blood glucose levels, as anticonvulsants can sometimes affect metabolic processes, there is no absolute contraindication for valproic acid in diabetic patients. However, appropriate monitoring of blood sugar levels would be necessary to adjust any diabetic treatment as needed.

C. A patient with asthma:
There is no direct contraindication to using valproic acid in a patient with asthma. While asthma medications and their interactions should always be considered, valproic acid does not typically exacerbate asthma symptoms. The prescription would be based on the clinical need for seizure management and monitored for any potential respiratory side effects.

D. A pregnant patient:
Valproic acid is contraindicated in pregnancy due to its high risk of causing fetal harm. It has been associated with an increased risk of birth defects, including neural tube defects, and other complications such as developmental delays. The U.S. FDA classifies valproic acid as a Category D drug for pregnancy, indicating that it should only be used when the potential benefits outweigh the risks. Thus, it should be avoided in pregnant patients unless no safer alternatives are available.

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Free Nursing Study Resources

Correct Answer is A

Explanation

A. NG tube placement:
In patients with an exacerbation of inflammatory bowel disease (IBD), particularly in cases of severe flare-ups, the gastrointestinal tract may need rest, and the patient may have difficulty maintaining adequate nutrition. An NG (nasogastric) tube may be used for enteral feeding if the patient is unable to tolerate oral intake, or to provide bowel rest if indicated. Nutritional support via an NG tube can help provide essential nutrients and manage symptoms during an exacerbation, especially if the patient is experiencing severe nausea, vomiting, or malabsorption.

B. Low calorie and low protein diet:
During an IBD flare, the patient typically needs a higher-calorie, higher-protein diet to support healing and immune function. A low-calorie, low-protein diet would not be appropriate, as it would not provide the necessary nutrients for recovery and tissue repair. In fact, nutritional support is often one of the key components in managing IBD exacerbations. A diet rich in calories and protein is often recommended to prevent malnutrition.

C. Stool softeners and laxatives:
Stool softeners and laxatives are generally contraindicated during an IBD flare, as they can exacerbate diarrhea and increase bowel motility, which may worsen symptoms such as abdominal pain, cramping, and diarrhea. The focus during an exacerbation of IBD is typically on controlling inflammation, rest, and reducing bowel irritation, rather than promoting bowel movements.

D. Barium contrast imaging studies:
Barium contrast imaging studies are generally not performed during an acute exacerbation of IBD because they can cause further irritation to the inflamed bowel. Imaging studies are typically used for diagnosis and assessment of disease extent in a stable or chronic phase, rather than during an acute flare. The priority during a flare is managing symptoms and controlling inflammation, not conducting procedures that could aggravate the condition.

A. Instruct the patient to swallow the medication with the head tilted backwards B. Place the medication in the backwards in the back of the mouth on the affected side C. Evaluate the patient’s ability to swallow D. Provide the patient with thickened liquids

Correct Answer is C

Explanation

A) Instruct the patient to swallow the medication with the head tilted backwards:
Tilting the head backward while swallowing may worsen the patient's ability to swallow, especially if they are experiencing facial droop and slurred speech. This position could increase the risk of aspiration or choking. A safer approach involves evaluating the patient’s swallowing ability before giving any oral medications.

B) Place the medication in the back of the mouth on the affected side:
While placing the medication on the unaffected side might seem like an alternative to help with swallowing, it is still important to assess the patient's swallowing ability first. If the patient has difficulty swallowing due to neurological deficits, placing the medication on the affected side could increase the risk of aspiration, leading to complications such as pneumonia.

C) Evaluate the patient’s ability to swallow:
Evaluating the patient's ability to swallow is the most important initial action. Facial droop and slurred speech can indicate potential dysphagia or difficulty swallowing, which could lead to aspiration if medications are given orally without further assessment. The nurse must determine if the patient can swallow safely before administering any oral medications, including aspirin, to prevent complications.

D) Provide the patient with thickened liquids:
Thickened liquids may be helpful for patients with known dysphagia, but this approach is not suitable in this case because the first priority is assessing the patient's swallowing ability. Giving thickened liquids without evaluating swallowing could increase the risk of aspiration if the patient is unable to manage liquids safely. An evaluation should precede any interventions like thickening liquids.

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In which client would a prescription of valproic acid for seizure disorder be contraindicated?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is caring for a client with an exacerbation of inflammatory bowel disease: Which of the following orders would be anticipated for this patient?

Correct Answer is A

Explanation

The nurse is caring for a client in the emergency department who is experiencing facial droop and slurred speech orally. The physician ordered aspirin to be given orally. What should the nurse do?

Correct Answer is C

Explanation

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