Question

a nurse is teaching a client who has bipolar disorder and a new prescription for carbamazepine. which of the following instructions should the nurse include in the teaching? a \this medication can safely be taken during pregnancy.\ b \eliminate grapefruit juice from your diet.\ c \you will need to have a complete blood count and carbamazepine levels drawn periodically.\ d
otify your provider if you develop a rash.\ e \avoid driving for the first few days after starting this medication.\

Explanation:

• Option A: Carbamazepine is a pregnancy category D medication (evidence of risk in humans; benefits may warrant use despite potential risks). It is not safe to take during pregnancy, so this option is incorrect.
• Option B: Grapefruit juice inhibits the cytochrome P - 450 CYP3A4 enzyme. Carbamazepine is metabolized by this enzyme. Taking grapefruit juice can lead to increased carbamazepine levels (risk of toxicity), so eliminating it from the diet is correct.
• Option C: Carbamazepine can cause agranulocytosis (low white blood cells) and other blood dyscrasias. Monitoring complete blood count is necessary. Also, therapeutic drug monitoring (carbamazepine levels) is done because of a narrow therapeutic index. So this instruction is correct.
• Option D: Carbamazepine can cause Stevens - Johnson syndrome (a serious and potentially fatal skin reaction). Instructing the client to notify the provider if a rash develops is crucial as a rash can be an early sign of this syndrome.
• Option E: Carbamazepine can cause drowsiness, dizziness, and ataxia (impaired balance and coordination) especially in the initial days. Advising the client to avoid driving for the first few days is a valid safety instruction.

Answer:

B. “Eliminate grapefruit juice from your diet.”
C. “You will need to have a complete blood count and carbamazepine levels drawn periodically.”
D. “Notify your provider if you develop a rash.”
E. “Avoid driving for the first few days after starting this medication.”