A client with bipolar disorder is receiving valproic acid 1,000 mg PO at bedtime. Prior to administering the medication, the nurse notes that the client's morning valproic acid level was 142 mcg/ml (984.63 mcmol/L). Which action should the nurse implement? Reference Range: Valproic Acid [50 to 100 mcg/mL (350 to 700 mcmol/L)]

Rationale: A. Give the dose the following morning: Delaying the dose until the next morning does not address the underlying issue of a toxic serum drug level. Administering more medication without provider guidance could worsen toxicity and place the client at serious risk. B. Notify the healthcare provider: The client’s valproic acid level is above the therapeutic range, indicating potential toxicity. Immediate notification of the provider is essential so that the medication regimen can be reassessed or adjusted to prevent complications. C. Determine time the specimen was collected: Knowing when the blood sample was drawn helps interpret whether the level represents a peak or trough. While useful information, this does not replace notifying the provider about a level that is already critically high and unsafe. D. Review liver function test findings: Monitoring liver function is important because valproic acid can cause hepatotoxicity. However, this is secondary to alerting the provider about the supratherapeutic concentration so that immediate management decisions can be made.