# A nurse is teaching a client newly prescribed valproic acid (valproate) about symptoms that require immediate provider notification. Which set of symptoms must the nurse emphasize?

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> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A nurse is teaching a client newly prescribed valproic acid (valproate) about symptoms that require immediate provider notification. Which set of symptoms must the nurse emphasize?

## Option

1. A 1-2 lb weight gain over the first month
2. Brief mild drowsiness in the first week
3. Persistent abdominal pain, vomiting, anorexia, jaundice, or easy bruising **✔ Correct answer**
4. Mild gum bleeding when brushing

**Correct answer: 3**

## Explanation

Correct (2): Valproate carries boxed warnings for hepatotoxicity (anorexia, vomiting, jaundice, easy bruising from impaired coagulation) and pancreatitis (severe abdominal pain, vomiting). Both are life-threatening and require immediate evaluation with LFT, lipase, ammonia. (1) Mild gum bleeding can occur from any cause and is not a red flag alone. (3) Some weight gain is expected. (4) Mild drowsiness early in therapy is common and self-limited.

## In-depth explanation

Memory Tip Valproate "VALPro" red flags = Vomiting, Anorexia, Liver(jaundice), Pancreatitis(abdominal pain). CPG Baseline LFT, ammonia, platelets; recheck periodically.

## Clinical scenario

Scenario 31-year-old female with bipolar disorder starting valproic acid 500 mg PO BID. Receiving outpatient teaching about red-flag adverse effects.

## Key concepts

- **Hepatotoxicity** — Drug-induced liver injury; valproate boxed warning, especially in children
- **Pancreatitis** — Inflammation of the pancreas; rare but serious valproate adverse effect requiring drug discontinuation.
- **Hyperammonemia** — Elevated blood ammonia from valproate inhibition of urea cycle; can cause encephalopathy even with normal LFTs.

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