A nurse is caring for an adolescent client who is pregnant with their second child and is experiencing anxiety. Which of the following statements should the nurse make?

Rationale:

A. "I should take this medication on an empty stomach.": Amitriptyline does not require administration on an empty stomach. It can be taken with or without food, although taking it with food may help reduce gastrointestinal discomfort in some individuals.

B. "I can continue to take St. John's wort while taking this medication.": St. John's wort can increase the risk of serotonin syndrome and reduce the effectiveness of amitriptyline due to drug interactions. Clients should avoid combining herbal supplements with antidepressants.

C. "I know it will be a couple of weeks before the medication helps me feel better.": Tricyclic antidepressants like amitriptyline take 2 to 4 weeks to show noticeable improvement in mood. Recognizing the delayed onset helps set realistic expectations and supports adherence.

D. "I expect this medication to raise my blood pressure.": Amitriptyline more commonly causes orthostatic hypotension, especially when therapy is initiated. Clients should be taught to change positions slowly to reduce the risk of dizziness and falls.

Rationale for correct choices:

• A change in mood: Isotretinoin is associated with serious neuropsychiatric side effects, including depression, mood swings, and suicidal ideation. Adolescents are particularly vulnerable, and any mood changes should be reported immediately to prevent potential harm.
• Decreased night vision: Isotretinoin can cause visual disturbances, including impaired night vision, which may develop suddenly and without warning. This adverse effect can pose safety risks, especially when driving or navigating in low-light conditions, and requires prompt provider evaluation.

Rationale for incorrect choices:

• Dry mouth: Dry mucous membranes are a common and expected side effect of isotretinoin due to its drying effects on the skin and mucosa. While it may cause discomfort, it is not typically urgent or dangerous unless accompanied by other systemic symptoms.
• The development of dry eyes: Dry eyes are a frequent and expected adverse effect of isotretinoin. This symptom can usually be managed with artificial tears or lubricating eye drops and does not require immediate provider notification unless severe or worsening.
• Sunburn: Isotretinoin increases photosensitivity, making clients more prone to sunburn. However, this is a manageable and anticipated side effect. The client should be advised to use sunscreen and protective clothing rather than treat it as an emergency.
• Engagement in sexual activity: Sexual activity becomes relevant only if pregnancy is a risk, due to isotretinoin’s severe teratogenicity. Since the client currently tests negative on hCG and is not sexually active, it is not a priority concern unless that status changes.
• Worsening of acne: A temporary worsening of acne, known as an initial flare, is common in the first few weeks of isotretinoin therapy. It is not considered dangerous and does not warrant immediate discontinuation or urgent evaluation unless accompanied by severe systemic symptoms.