A nurse is caring for a client who has bipolar disorder and a new prescription for valproate. Which of the following instructions should the nurse give the client about the use of this medication?

A. Thyroid function tests should be performed every 6 months. While thyroid function tests may be important for clients with bipolar disorder, they are not specifically required for clients taking valproate. The primary monitoring focus for valproate therapy is liver function, especially in the initial stages of treatment. B. High serum sodium levels can cause toxic levels of valproate. Low serum sodium levels (not high) can increase the risk of valproate toxicity. High sodium levels do not have a direct effect on valproate toxicity. C. A pretreatment electroencephalogram (EEG) will be done. An EEG is not required for all clients who start valproate. While EEGs may be used in certain cases of epilepsy or other neurological conditions, they are not a routine part of monitoring when starting valproate for bipolar disorder. D. Liver function tests must be monitored. Valproate can cause liver toxicity, especially during the initial months of treatment. Therefore, liver function tests (such as ALT and AST) should be closely monitored for the first few months, and then periodically throughout treatment.