A nurse is caring for a 30-month-old child. Which of the following activities should the nurse expect the child to participate in?

Rationale:

• Hallucinations: Auditory hallucinations, such as the client reporting listening to unseen others, are a hallmark symptom of psychosis. This indicates a break from reality and requires close psychiatric monitoring.
• Lack of sleep: Sleep deprivation is common in manic episodes due to heightened energy and decreased need for rest. Chronic sleep loss in mania can exacerbate irritability, impulsivity, and cognitive impairment.
• Pressured speech: Rapid, loud, and continuous speech is characteristic of mania. It reflects heightened energy, distractibility, and impaired judgment, often making communication difficult for caregivers.
• Excessive spending habits: Impulsive financial decisions and risky behaviors, such as giving away large sums of money, are indicative of manic episodes. These behaviors can have serious social and financial consequences.
• Disorganized thought process: Disorganized thinking can occur in both psychosis and mania. In psychosis, it may manifest as illogical or tangential thought patterns, while in mania, racing thoughts can disrupt coherent speech and planning.

Rationale for Correct Choices:

• A change in mood: Isotretinoin can cause psychiatric effects such as depression, mood swings, and suicidal ideation. These symptoms may appear suddenly and progress rapidly without warning. Immediate reporting is necessary to ensure patient safety and initiate intervention.
• Visual disturbances: Isotretinoin may cause night blindness, blurred vision, or other changes in visual acuity. These effects can be irreversible if not addressed promptly by an ophthalmologic evaluation. Sudden onset visual changes require immediate discontinuation and assessment.

Rationale for Incorrect Choices:

• Nausea: This is a mild, nonspecific gastrointestinal symptom that may occur with many oral medications. It is not considered a hallmark of isotretinoin toxicity unless severe or persistent. Supportive measures are usually sufficient unless other symptoms emerge.
• The development of dry eyes: This occurs due to isotretinoin’s suppression of sebaceous and meibomian gland activity. It is a common, expected effect that can be relieved with lubricating eye drops. Urgent evaluation is not required unless accompanied by vision changes.
• Dry mouth: This is a frequent mucocutaneous effect related to reduced salivary gland activity during isotretinoin therapy. It does not indicate a dangerous reaction and is usually managed with hydration and sugar-free lozenges. Medical review is only needed if severe.
• Photosensitivity: Isotretinoin increases skin sensitivity to sunlight due to thinning of the epidermis. While uncomfortable, it is a predictable effect that can be prevented with sunscreen and protective clothing. It does not require stopping treatment unless severe burns occur.
• Dry skin and lips: This is the most common side effect, resulting from reduced sebaceous gland activity. It is usually managed with moisturizers and lip balm throughout therapy. It is not a sign of toxicity and rarely requires dose adjustment.