P​‌‍‍‍‌‍‌‍‍‍‌‌‌‍‌‌‌‌‌‌​lease note the following requirements: A minimum of 150 w

P​‌‍‍‍‌‍‌‍‍‍‌‌‌‍‌‌‌‌‌‌​lease note the following requirements: A minimum of 150 words, scholarly written, APA formatted. A minimum of 2 references are required. Peer reviewed scholarly resources should be no more than 5 years old. Example: professional, peer reviewed publications or reports from resources such as CDC, IOM, AACN, etc. These should be written by professionals and scholars in the field. Websites are only scholarly, if written by professionals and experts in the area. Wikipedia is not a scholarly source, for example. A website such as Medscape, CDC, and TIGER Initiative are examples of scholarly sources.
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A patient has been taking valproic acid for mood stabilization from a manic episode but is still not sleeping through the night. His last drug level was 50mcg/ml. The PMHNP notices the patient seems disoriented to time and is flapping his wrist. What should the PMHNP do next?
A. Give the patient lactulose 20 g PO
B. Draw an ammonia level
C. Increase the dose of valproic acid
D. Augment with an atypical antipsychotic
The correct answer for the above question is B. Draw an ammonia level
What is the rationale for option B being the correct answer ?
Why is option A, C and D are incorrect​‌‍‍‍‌‍‌‍‍‍‌‌‌‍‌‌‌‌‌‌​?

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