A nurse is providing education about the common causes of polyuria to a client who has a urinary alteration. Which of the following client statements indicates an understanding of the teaching?

Rationale:

A. Perform a sterile dressing change for a client who has an abdominal wound: LPNs can perform sterile procedures and wound care on stable clients, making this an appropriate delegated task.

B. Complete the Glasgow Coma Scale for a client who has an evolving stroke: Neurological assessments on unstable or acutely changing clients require RN judgment and should not be delegated to an LPN.

C. Perform an admission assessment for a client who is scheduled for surgery: Admission assessments require comprehensive data collection, interpretation, and nursing judgment, which fall under the RN scope of practice.

D. Complete discharge teaching for a client who has a new diagnosis of diabetes mellitus: Discharge teaching for a new condition involves complex education and evaluation of understanding, which are RN responsibilities.

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.