A nurse is teaching a female adolescent client about isotretinoin (Accutane) for severe acne. Which statement by the client indicates a need for further teaching?

• "I need to use two forms of birth control while taking this medication."  

• "I will avoid donating blood during and shortly after treatment." 

• "This medication may cause dry skin and lips."  

• "Once I stop the medication, I can try to get pregnant right away."

Answer explanation

Isotretinoin is highly teratogenic. Patients should avoid pregnancy for a specific period (commonly at least one month, though some providers recommend longer) after discontinuation to prevent fetal harm.

A client taking isotretinoin (Accutane) reports persistent sadness and loss of interest in activities. What is the nurse’s priority action? 

• Document the findings and schedule a follow-up visit.  

• Refer the client to a dermatologist. 

• Educate the client that mood changes are common and usually resolve.  

• Notify the healthcare provider immediately. 

Answer explanation

Isotretinoin can cause serious psychiatric side effects including depression and suicidal ideation. These symptoms must be promptly reported for evaluation.

The nurse reinforces teaching to a client prescribed isotretinoin (Accutane). Which of the following statements should be included in the teaching? Select all that apply.

• “Wear sunscreen daily while on this medication.”  

• “You should stop using lip moisturizer to prevent irritation.” 

• “Routine liver function tests may be ordered.” 

• “You may experience dryness of the eyes and nose.”  

• “The drug can cause permanent infertility.” 

Answer explanation

Photosensitivity, mucocutaneous dryness, and hepatotoxicity are known side effects. Lip moisturizer should be encouraged and infertility is not a known adverse effect.

A nurse is reviewing lab values for a client on isotretinoin (Accutane). Which lab result would be concerning in relation to the client's acne treatment? 

• Elevated triglycerides

• Increased white blood cell count  

• Decreased hemoglobin  

• Elevated platelet count 

Answer explanation

Isotretinoin can increase lipid levels, particularly triglycerides, which could pose a cardiovascular risk and require discontinuation or adjustment. 

A client has previously tried to treat acne topically with benzol peroxide with little success. She is then prescribed spironolactone (Aldactone) for systemic treatment. Which of the following are potential adverse effects of this medication? Select all that apply.

• Decreased libido

• Teratogenic effects if the client became pregnant

• Increased potassium levels

• Decreased calcium levels

• Urinary retention

Answer explanation

Spironolactone is an aldosterone receptor blocker that also has anti-androgen effects - this is why it works for hormonal acne. It causes retention of potassium, is teratongenic and can cause decreased libido (due to it's anti-androgen effects). It has no effect on calcium levels and will not cause urinary retention. It is a weak diuretic.