A nurse is caring for an adolescent in the outpatient dermatologist's office. Complete the following sentence by using the lists of options. A nurse is providing education today on the newly-prescribed medication. The nurse recommends the adolescent notify the provider immediately if _____ or _____ occurs during therapy.

Rationale for correct choices • A change in mood: Isotretinoin therapy carries a risk of psychiatric adverse effects, including depression, mood swings, and suicidal ideation. Adolescents are particularly vulnerable, and early recognition of mood changes is essential. Prompt reporting allows the provider to evaluate mental health status, adjust therapy, or provide appropriate support. Monitoring mood is a critical safety measure during treatment. • Decreased night vision: Isotretinoin can impair dark adaptation and cause decreased night vision due to its effects on the retina. The adverse effect may be sudden and irreversible making it important for the teen to report early incase of visual changes. Rationale for incorrect choices • Nausea: Mild nausea is a common and expected side effect of isotretinoin but is not immediately dangerous. While the adolescent should report severe or persistent gastrointestinal symptoms, routine nausea does not warrant urgent provider notification. It is managed symptomatically. • Dry mouth: Dry mouth is a frequent, expected side effect of isotretinoin and can be managed with increased hydration or oral care. It does not indicate a serious adverse event and does not require immediate provider notification. • The development of dry eyes; Dry eyes are a common, non-urgent side effect of isotretinoin therapy. Lubricating eye drops and proper eye care usually manage this symptom. Immediate reporting is unnecessary unless severe or persistent symptoms develop. • Worsening of acne: Transient worsening of acne may occur early in isotretinoin therapy and is often expected. While persistent or severe exacerbation should be discussed at follow-up, it does not require immediate notification. Early flare is typically self-limiting. • Engagement in sexual activity: Although pregnancy prevention is critical while using isotretinoin due to teratogenicity, sexual activity alone does not represent a medical related complication. The client hcg tests are negative, hence no concern for teratogenic effects. • Sunburn: Photosensitivity is a known effect of isotretinoin, but sunburn is preventable with sunscreen and protective clothing. Reporting is not urgent unless severe or recurrent, and general sun precautions are emphasized during education.