A nurse is assisting with screening a client for scoliosis. Which of the following actions should the nurse ask the client to perform?

A. Massage the lower leg in smooth, long strokes: Massaging the lower leg after knee arthroplasty increases the risk of dislodging a thrombus, especially in the early postoperative period when the client is at high risk for deep vein thrombosis. Mechanical manipulation of the limb should be avoided to reduce embolic risk.

B. Place a pillow under the client's surgical knee: Placing a pillow under the knee promotes flexion and can lead to joint contractures. After knee arthroplasty, the knee should be kept in extension to support proper alignment and prevent stiffness. A pillow may be placed under the calf instead if elevation is needed.

C. Use the continuous passive-motion machine intermittently: Continuous passive-motion machines are used early after knee arthroplasty to improve joint mobility, reduce stiffness, and promote circulation. Intermittent use as prescribed helps maintain range of motion without overfatiguing the joint. This intervention supports functional recovery and rehabilitation.

D. Apply warm, moist packs to the surgical site: Warm packs increase blood flow and may worsen postoperative swelling or bleeding at the surgical site. Cold therapy is preferred in the immediate postoperative period to reduce inflammation, pain, and edema. Warm applications are not appropriate at this stage of recovery.

Rationale for correct choices:
• a change in mood: Isotretinoin has been associated with psychiatric effects including depression, mood swings, aggression, and suicidal ideation, particularly in adolescents. Any noticeable mood or behavioral changes require immediate provider notification so the medication can be reassessed and mental health support initiated if needed.

• decreased night vision: Isotretinoin can impair dark adaptation and cause decreased night vision due to its effects on the retina. This adverse effect may be sudden or irreversible, making early reporting essential to prevent safety risks such as accidents while driving in low-light conditions.

Rationale for incorrect choices:
• nausea: Mild gastrointestinal upset can occur with isotretinoin and is generally expected rather than emergent. This symptom is usually managed with supportive measures and does not require immediate discontinuation unless severe or persistent.

• dry mouth: Mucocutaneous dryness, including dry lips and mouth, is a very common and expected side effect of isotretinoin. This is typically managed with hydration and emollients and does not warrant urgent provider notification.

• the development of dry eyes: Dry eyes are a common isotretinoin effect related to decreased sebaceous gland activity. While uncomfortable and relevant to report at routine follow-up, it is not an urgent finding unless severe or affecting vision.

• sunburn: Photosensitivity can occur during isotretinoin therapy, making sunburn more likely. This is addressed with sun protection education and does not indicate a serious adverse reaction requiring immediate notification.

• engagement in sexual activity: Sexual activity itself is not an adverse effect of isotretinoin. Although pregnancy prevention is critical due to teratogenicity, sexual activity alone does not represent a medication-related complication.

• worsening of acne: Acne may initially worsen during early isotretinoin therapy as part of the treatment response. This is a known and expected effect and does not require urgent provider contact unless severe or accompanied by systemic symptoms.