A nurse is assisting with the care of an adolescent in an outpatient dermatologist's office.

Complete the following sentence by using the lists of options.

A nurse is reinforcing teaching today on the newly prescribed medication. The nurse recommends that the adolescent notify the provider immediately if there is
dropdown
or
dropdown
occurs during therapy.

Answer and Explanation

The Correct Answer is {"dropdown-group-1":"C","dropdown-group-2":"A"}

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.

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Correct Answer is A

Explanation

A. The client has a sudden increase in energy: A sudden increase in energy in a client with major depressive disorder can indicate an elevated risk for suicidal behavior, especially if the client previously had low motivation or lethargy. This change is an urgent safety concern and should be reported immediately.

B. The client reports a change in sleeping patterns: Changes in sleep are common in depression and with antidepressant therapy. While important to monitor, they are not as immediately life-threatening as sudden energy changes that could precede suicidal actions.

C. The client is withdrawn and uncommunicative: Social withdrawal is a common symptom of depression. While concerning, it does not require the same urgent response as a sudden increase in energy that could indicate imminent risk.

D. The client neglects personal hygiene: Poor self-care is typical in depression and should be addressed in ongoing care, but it does not present the same immediate risk as potential suicidal behavior.

A. Gently massage the eyelid to facilitate absorption of the medication B. Wipe any excess medication from the inner canthus outward C. Instruct guardian to apply erythromycin ophthalmic ointment every morning for 14 days. D. Place an occlusive dressing on the affected eye to prevent the spread of infection.

Correct Answer is B

Explanation

A. Gently massage the eyelid to facilitate absorption of the medication: Massaging the eyelid is not recommended because it can spread the infection to surrounding tissues and increase irritation. Medication should remain in the conjunctival sac for absorption.

B. Wipe any excess medication from the inner canthus outward: After applying ophthalmic ointment, wiping from the inner canthus (near the nose) outward prevents contamination of the tear duct and reduces the risk of spreading the infection to the other eye or face.

C. Instruct guardian to apply erythromycin ophthalmic ointment every morning for 14 days: The prescribed medication is bacitracin, not erythromycin. Providing the correct drug and following the prescribed dosing schedule is essential for effective treatment.

D. Place an occlusive dressing on the affected eye to prevent the spread of infection: An occlusive dressing is not indicated for bacterial conjunctivitis. Proper hand hygiene and avoiding contact with the eye are sufficient to prevent transmission.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has major depressive disorder and is taking an antidepressant. The nurse should identify which of the following findings as the priority to report to the provider?

Correct Answer is A

Explanation

A nurse is caring for a 3-year-old child who has acute bacterial conjunctivitis of the right eye and has been prescribed bacitracin ophthalmic ointment. Which of the following actions should the nurse take?

Correct Answer is B

Explanation

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