A patient receiving valproic acid (Depakote) should be monitored for which adverse effects? (Select all that apply. One, some or all)

A. Valproic acid can trigger cutaneous reactions, ranging from mild rashes to, rarely, serious hypersensitivity reactions such as Stevens-Johnson syndrome. Nurses should instruct patients to report any new skin changes, redness, itching, or widespread rash immediately, as early recognition can prevent serious complications. B. Tremors are a common neurologic side effect, usually dose-related, affecting the hands or arms. They can interfere with daily activities and may require dose adjustment or monitoring by the provider. Nurses should assess for tremor during routine neurological evaluations and educate the patient about possible onset and severity. C. Valproic acid can cause temporary, reversible hair loss, typically within the first several months of therapy. While not life-threatening, alopecia can affect patient self-esteem and adherence, so the nurse should provide reassurance and discuss strategies such as gentle hair care. D. Hepatic injury is a serious potential adverse effect of valproic acid, especially in children under 2 years, those with polytherapy, or pre-existing liver disease. Nurses should monitor liver function tests (AST, ALT, bilirubin) periodically, and educate patients to report jaundice, dark urine, nausea, abdominal pain, or unusual fatigue immediately. Early detection is critical to prevent acute liver failure. E. While nausea, vomiting, or mild gastrointestinal upset may occur with valproic acid, significant appetite reduction is uncommon. Nurses should monitor overall nutritional status, but appetite changes are not considered a primary adverse effect of the drug.