# Situation: A nurse at a Rural Health Unit (RHU) trained in the World Health Organization Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) follows up a 24-year-old woman who has just been diagnosed with epilepsy and started on carbamazepine. She lives with her husband and works as a store clerk. According to mhGAP-IG, what daily dose of folic acid should the nurse advise for her?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630103  
> language: ko  
> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: A nurse at a Rural Health Unit (RHU) trained in the World Health Organization Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) follows up a 24-year-old woman who has just been diagnosed with epilepsy and started on carbamazepine. She lives with her husband and works as a store clerk.

According to mhGAP-IG, what daily dose of folic acid should the nurse advise for her?

## 보기

1. 0.4 mg
2. 4 mg
3. 5 mg **✔ 정답**
4. 10 mg

**정답: 3**

## 해설

mhGAP-IG advises folate 5 mg a day for all women of childbearing age who have epilepsy, whether or not they are planning a pregnancy. The 0.4 mg dose is the usual supplement for the general population, and 4 mg is a dose used in some other guidelines, so the stem fixes the mhGAP-IG rule.

## 심화 해설

The mhGAP-IG folate dose
This 24-year-old woman has just been diagnosed with epilepsy and started on carbamazepine. The WHO mhGAP Intervention Guide advises folic acid 5 mg a day for all women of childbearing age who have epilepsy, whether or not they are planning a pregnancy. The correct answer is 5 mg daily, the mhGAP-IG recommendation. The advice applies to every woman of childbearing potential with epilepsy, because many pregnancies are unplanned and neural tube closure happens very early, often before a woman knows she is pregnant.

Why folate matters with antiseizure medicines
Several antiseizure medicines, including carbamazepine and valproate, interfere with folate metabolism and are associated with an increased risk of neural tube defects and other birth defects. Folate supplementation before conception and in early pregnancy reduces this risk. Carbamazepine is also an enzyme inducer that lowers the effectiveness of hormonal contraceptives, so she should receive counseling about reliable contraception and about planning any pregnancy with her health worker.

| Dose | Context | Correct for this question? |
| --- | --- | --- |
| 0.4 mg | General preconception supplement | No |
| 4 mg | High-risk dose in some other guidelines | No |
| 5 mg | mhGAP-IG: all women of childbearing age with epilepsy | Yes |
| 10 mg | Double the recommended dose | No |

Why the other doses are wrong
0.4 mg is the usual supplement for the general population of women planning pregnancy, not the mhGAP-IG dose for women with epilepsy. 4 mg is a high-risk dose used in some other guidelines, but the stem specifies mhGAP-IG, which fixes the answer at 5 mg. 10 mg is double the recommended dose and is not advised.

Watch out! When a question names a specific guideline, answer according to that guideline even if other sources use a different number. Here the phrase "According to mhGAP-IG" points to 5 mg.

Exam takeaway
Key point! mhGAP-IG advises folic acid 5 mg daily for all women of childbearing age with epilepsy. Combine this with contraception counseling, since carbamazepine reduces the effect of hormonal methods, and with planning for any pregnancy.

## 임상 시나리오

Folic Acid in Women with EpilepsymhGAP-IG recommendation
mhGAP-IG advises folic acid 5 mg daily for all women of childbearing age with epilepsy, whether or not they plan pregnancy.

Antiseizure medicines such as carbamazepine raise the risk of neural tube defects. Folate before conception and in early pregnancy lowers this risk.

Carbamazepine reduces the effect of hormonal contraceptives, so counsel her about reliable contraception and pregnancy planning.

CautionThe 0.4 mg dose is for the general population; the question names mhGAP-IG, which sets 5 mg.

## 핵심 개념

- **Folic acid** — A B vitamin that, taken before and in early pregnancy, reduces the risk of neural tube defects.
- **Carbamazepine** — An antiseizure medicine that induces liver enzymes and can affect folate and hormonal contraception.
- **Neural tube defect** — A birth defect of the brain or spinal cord, such as spina bifida, from incomplete neural tube closure.
- **mhGAP-IG** — The WHO guide for managing priority mental, neurological, and substance use conditions in non-specialist care.

## 같은 주제 문제

- [Situation: A 29-year-old man is admitted to the psychiatric unit of a general hospital aft…](https://mymerci.kr/pages/nclex_q.php?qn_id=629986)
- [Situation: A 29-year-old man is admitted to the psychiatric unit of a general hospital aft…](https://mymerci.kr/pages/nclex_q.php?qn_id=629987)
- [Situation: A 29-year-old man is admitted to the psychiatric unit of a general hospital aft…](https://mymerci.kr/pages/nclex_q.php?qn_id=629988)
- [Situation: A 29-year-old man is admitted to the psychiatric unit of a general hospital aft…](https://mymerci.kr/pages/nclex_q.php?qn_id=629989)
- [Situation: A 52-year-old man is seen at the outpatient mental health clinic of a provincia…](https://mymerci.kr/pages/nclex_q.php?qn_id=629990)
- [Situation: A 52-year-old man is seen at the outpatient mental health clinic of a provincia…](https://mymerci.kr/pages/nclex_q.php?qn_id=629991)
- [Situation: A 52-year-old man is seen at the outpatient mental health clinic of a provincia…](https://mymerci.kr/pages/nclex_q.php?qn_id=629992)
- [Situation: A 40-year-old woman is admitted to the psychiatric ward with major depressive d…](https://mymerci.kr/pages/nclex_q.php?qn_id=629993)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._