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?

• Dry skin and lips: This is a very common side effect of isotretinoin due to its drying effects on sebaceous glands. It is expected and manageable with regular moisturizing and is not considered an emergency.
• Increased appetite: Isotretinoin is not associated with increased appetite. Weight changes are not typical or concerning symptoms during therapy and do not warrant urgent provider notification.
• Depression: Isotretinoin has been associated with mood changes including depression, suicidal thoughts, and other psychiatric effects. These can emerge suddenly and must be reported immediately for prompt evaluation and intervention to ensure safety.
• Visual disturbances: Blurred vision or difficulty seeing, particularly at night, can indicate rare but serious complications such as increased intracranial pressure. Any change in vision during isotretinoin therapy requires immediate medical attention.
• Productive cough: This is not commonly linked with isotretinoin therapy. Unless respiratory symptoms worsen or are accompanied by fever or systemic signs, a productive cough alone is not a reason to stop treatment or alert the provider urgently.

A. Beneficence. This principle refers to acting in the best interest of the client by promoting their well-being and providing comfort. Sitting with a grieving client to offer emotional support is an act of kindness and compassion, aligning with beneficence.
B. Autonomy. Autonomy involves respecting the client’s right to make decisions about their own care. While important, it is not the primary ethical principle demonstrated in this situation.
C. Fidelity. Fidelity refers to keeping promises and maintaining trust in the nurse-client relationship. While the nurse is being supportive, the act described does not specifically demonstrate the principle of fidelity.
D. Veracity. Veracity involves telling the truth and being honest with clients. It is not the relevant principle in this context, as the focus is on emotional support rather than the communication of factual information.