An adolescent receives a new prescription for isotretinoin for cystic acne. Which information is most important for the nurse to provide?

Start the second course of therapy after an 8-week delay.

Consider an alternative summer job, other than life guarding.

Store the medicine in a plastic, tight, light resistant container.

Discontinue all multivitamins during acne medication therapy.

Answer and Explanation

The Correct Answer is B

A. Start the second course of therapy after an 8-week delay: While a second course of isotretinoin may sometimes be considered after a break if acne persists, this timing is medication management guidance and is less urgent than immediate safety concerns like sun sensitivity.

B. Consider an alternative summer job, other than life guarding: Isotretinoin causes extreme photosensitivity, making prolonged sun exposure dangerous. Adolescents working outdoors, like lifeguards, are at high risk for severe sunburns, so suggesting alternative employment protects their health.

C. Store the medicine in a plastic, tight, light resistant container: Proper medication storage is important but not the most critical concern compared to preventing serious adverse effects like sunburn, teratogenicity, or psychiatric symptoms with isotretinoin use.

D. Discontinue all multivitamins during acne medication therapy: There is generally no need to discontinue all multivitamins while taking isotretinoin unless specifically instructed by the healthcare provider. Some multivitamins contain vitamin A, excessive intake of vitamin A should be avoided. However, discontinuing all multivitamins without guidance could lead to other nutritional deficiencies.

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Correct Answer is A

Explanation

A. Acetaminophen: Acetaminophen is metabolized by the liver, and excessive or chronic use can lead to hepatotoxicity, which presents with signs such as jaundice. Observing jaundice in a client taking acetaminophen requires prompt notification of the healthcare provider to assess for potential liver damage.

B. Prednisone: Prednisone can have many systemic effects, including fluid retention and immune suppression, but it is not typically associated with liver toxicity or jaundice as a primary adverse effect.

C. Captopril: Captopril is used to manage hypertension and can cause renal dysfunction, but it is not commonly linked to liver dysfunction or jaundice. Liver-related side effects are rare with ACE inhibitors.

D. Omeprazole: Omeprazole is a proton pump inhibitor used for gastroesophageal reflux and has minimal hepatic side effects. It is not commonly associated with jaundice in clinical practice.

A. Document the client's refusal of the medication at this time. B. Explain the need to take the medication at least 1 hour before meals. C. Allow the client to take the medication up to 1 hour after breakfast. D. Instruct the client to take it when the meal tray is delivered.

Correct Answer is B

Explanation

A. Document the client's refusal of the medication at this time: While documentation is necessary if a medication is refused, the priority is to educate the client first. The nurse should explain the proper timing of sucralfate to promote understanding and adherence rather than simply accepting refusal.

B. Explain the need to take the medication at least 1 hour before meals: Sucralfate acts by forming a protective barrier over ulcerated mucosa and must be taken on an empty stomach for maximum effectiveness. Administering it one hour before meals ensures the stomach lining is properly coated before food intake.

C. Allow the client to take the medication up to 1 hour after breakfast: Taking sucralfate after a meal diminishes its ability to bind effectively to the mucosa. Food interferes with its action, so post-meal dosing is inappropriate for achieving therapeutic benefit.

D. Instruct the client to take it when the meal tray is delivered: Taking sucralfate at mealtime is too late for optimal therapeutic effect. At that point, gastric contents may interfere with its binding to ulcerated areas, reducing its protective action.

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An adolescent receives a new prescription for isotretinoin for cystic acne. Which information is most important for the nurse to provide?

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