A nurse is providing teaching to a 17-year-old female client who has severe acne about the use of isotretinoin. Which of the following adverse effects should the nurse instruct the client is the priority to report immediately to the provider?

A. Back pain may occur but is not typically urgent unless severe; it’s important to monitor but not the priority. B. Frequent nosebleeds can occur due to dry mucous membranes but are not the most critical symptom to report immediately. C. Itching of the skin can be managed with moisturizers and does not represent a medical emergency. D. Feelings of isolation and depression are serious side effects associated with isotretinoin and should be reported immediately due to the risk of self-harm or suicidal thoughts.