A nurse is providing preoperative teaching to an older adult female client who is scheduled for a laminectomy and uses supplements. Which of the following supplements should the nurse identify as increasing the client's risk for hypotension during surgery?

Rationale:

A. Use Leopold maneuvers to determine the fetal position: Leopold maneuvers are not appropriate as an immediate response to sudden nausea. The priority is to relieve the symptom, which may be related to positional compression of major blood vessels.

B. Position the client on her side: At 36 weeks gestation, the gravid uterus can compress the inferior vena cava when lying supine, leading to supine hypotensive syndrome. Symptoms like nausea, dizziness, and hypotension can occur. Side-lying positioning relieves the pressure and restores venous return and cardiac output.

C. Administer propranolol IV to the client: Propranolol is not indicated for treating pregnancy-related nausea or hypotension. Using it without a cardiovascular diagnosis would be inappropriate and could worsen hypotensive symptoms.

D. Ask the client to increase her daily calcium intake: While calcium is essential in pregnancy, especially for fetal bone development, increasing calcium intake has no immediate impact on sudden nausea or circulatory symptoms linked to maternal positioning.

Rationale for correct choices:

• A change in mood: Mood changes, including depression, irritability, or suicidal thoughts, are serious adverse effects associated with isotretinoin use. Adolescents are particularly vulnerable to these side effects, and any mood alterations during treatment warrant immediate provider notification.
• Decreased night vision: Isotretinoin can lead to visual disturbances, including decreased night vision, which may be sudden and irreversible. This adverse effect is rare but serious, and any signs of visual impairment should be reported promptly to prevent injury or permanent damage.

Rationale for incorrect choices:

• The development of dry eyes: Dry eyes are a common and expected side effect of isotretinoin, often due to mucous membrane dryness. While uncomfortable, it is not typically dangerous and can usually be managed with lubricating eye drops or supportive care without immediate provider contact.
• Dry mouth: Dry mouth occurs frequently with isotretinoin due to its drying effects on mucosal surfaces. It is bothersome but not dangerous, and clients can manage it with increased fluid intake and sugar-free lozenges. It doesn’t require urgent medical attention unless severe.
• Nausea: Nausea is not a common or concerning side effect of isotretinoin. If persistent or severe, it may require evaluation, but it is not a priority symptom for immediate provider contact unless accompanied by other warning signs like abdominal pain or jaundice.
• Sunburn: Increased photosensitivity is an expected effect of isotretinoin, and clients should be advised to wear sunscreen and protective clothing. Sunburn, while uncomfortable, is not an emergency and does not require immediate medical consultation unless it becomes severe.
• Worsening of acne: An initial acne flare is a known and expected part of isotretinoin therapy as pores begin to purge. This typically improves after several weeks and does not indicate treatment failure or require immediate provider notification unless accompanied by signs of infection.
• Engagement in sexual activity: While not a symptom, sexual activity is significant for female clients due to isotretinoin's teratogenicity. However, since this client has a negative hCG and is not sexually active, this is part of routine risk counselling not an immediate concern unless pregnancy is possible.