A nurse is caring for a client who is admitted to the medical-surgical unit.

Exhibits

The nurse reviews the client's laboratory findings and vital signs. Select the 5 findings that require immediate follow-up.

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.

Rationale:

A. A colleague who uses assertive communication: Assertive communication is a positive professional skill that promotes clarity and mutual respect. It involves expressing needs and opinions confidently while respecting the rights of others, not bullying behavior.

B. A colleague who is mindful of the personal space of other colleagues: Respecting personal space reflects professional courtesy and helps maintain a comfortable work environment. It does not represent any form of bullying or intimidation.

C. A colleague who negotiates with others for a win-win situation: Negotiation aimed at mutual benefit demonstrates collaboration and problem-solving, which are constructive workplace behaviors, not bullying tactics.

D. A colleague who finds fault with other colleagues: Habitually criticizing or fault-finding without constructive intent is a form of workplace bullying. This behavior undermines morale, creates a hostile environment, and can damage professional relationships.