A nurse is caring for a male client who is to begin therapy with valproic acid. Which diagnostic result should the nurse plan to review before administering the first dose?

• A. Prostate specific antigen test
• B. Chest x-ray
• C. Urine culture
• D. Liver function tests

Answer: (D)

Starting valproic acid requires checking liver safety first because this medication can cause hepatotoxicity, especially early in treatment. Reviewing baseline liver function tests helps identify any preexisting liver dysfunction and determines whether it’s safe to proceed or if closer monitoring or a different therapy is needed. Baseline tests typically include liver enzymes (AST/ALT) and bilirubin, among other markers, and they guide initial dosing decisions and safety planning. If these levels are normal, you can begin therapy with the understanding that LFTs should be monitored regularly after starting the drug, since elevations can develop as treatment continues. The other tests listed do not assess the risk of liver injury or inform the initial safety of valproic acid, so they aren’t required before the first dose. Remember also to educate about symptoms of liver trouble, such as fatigue, abdominal pain, nausea, vomiting, jaundice, or dark urine, and to report them promptly if they occur.