A client with a history of angina reports the onset of chest pain. The nurse determines that the heart rate is 104 beats/minute and the blood pressure is 138/86 mm Hg. A transdermal nitroglycerin patch was applied 30 minutes ago to the right upper chest. Which action should the nurse take?

A) A decreased peak and trough level may indicate subtherapeutic levels of the medication but do not pose an immediate risk to the client. Adjustments to the dosing regimen may be needed, but this finding does not require immediate action.

B) A decreased trough level alone may suggest a need for dosage adjustment but does not present an immediate risk to the client. It is important to monitor therapeutic drug levels, but this finding does not require immediate reporting to the healthcare provider.

C) An increased peak and trough level indicates potential toxicity of the medication. Increased peak levels can lead to nephrotoxicity, while increased trough levels can lead to ototoxicity. Both conditions are serious and require immediate action to prevent harm to the client. The nurse should report this finding immediately to the healthcare provider for further evaluation and possible adjustment of the medication regimen.

D) A decreased peak level alone may indicate subtherapeutic levels of the medication, but it does not pose an immediate risk to the client. Adjustments to the dosing regimen may be needed, but this finding does not require immediate action.

A) Breastfeeding is not recommended while taking this medication: While it’s important for clients to avoid breastfeeding while taking isotretinoin due to potential harm to the infant, the primary concern for a young adult female planning to become pregnant is the risk of teratogenic effects on the fetus. Therefore, while this information is relevant, it’s not the most important consideration in this situation.

B) Do not take multiple vitamins that contain vitamin A while taking this drug: Avoiding excessive intake of vitamin A is essential to prevent toxicity, but it’s not the most critical consideration for a client planning to become pregnant. The main concern is the teratogenic effects of isotretinoin on the fetus.

C) Baseline liver function results must be obtained during therapy: Monitoring liver function is important during isotretinoin therapy to assess for potential hepatotoxicity, but it’s not the most crucial consideration for a client planning to become pregnant. The primary concern is the need to discontinue the medication before conception to prevent fetal exposure.

D) Discontinue this medication one month before attempting to conceive: This is the most important information for the nurse to provide to the client. Isotretinoin is highly teratogenic and can cause severe birth defects if taken during pregnancy. Therefore, it’s essential for the client to discontinue isotretinoin at least one month before attempting to conceive to ensure the drug is cleared from the body and to prevent fetal exposure.