A nurse assesses a young female client who is prescribed tazarotene.
Which query should the nurse ask prior to starting this therapy?

Choice A rationale

Regular assessment for bleeding is critical because heparin inhibits the coagulation cascade by enhancing antithrombin III, which inactivates thrombin and factor Xa. This increases the risk of hemorrhage, so the nurse must monitor for signs like petechiae, ecchymosis, hematuria, or GI bleeding to prevent serious complications. Platelets should be maintained above 100,000.

Choice B rationale

The activated partial thromboplastin time (aPTT) measures the time it takes for a fibrin clot to form via the intrinsic and common pathways of the coagulation cascade. Heparin therapy is monitored by the aPTT, with a therapeutic range typically 1.5 to 2.5 times the client’s baseline or control value, usually 45-75 seconds.

Choice C rationale

Stopping an IV heparin infusion for an aPTT above baseline is not always the correct action, as the therapeutic range is purposefully elevated. The aPTT should be 1.5 to 2.5 times the control value. An aPTT above this therapeutic range warrants holding the dose or adjusting the rate according to established hospital protocols and provider orders.

Choice D rationale

Using an IV pump is essential for heparin infusion to ensure precise and consistent administration. Heparin is a high-alert medication with a narrow therapeutic index. An IV pump prevents boluses and ensures the client receives the exact prescribed dose over time, minimizing the risk of subtherapeutic levels or overdose.

Choice E rationale

Daily weighing is crucial for monitoring fluid balance and detecting fluid shifts, which can indicate internal bleeding, a significant risk with heparin. Using the same scale at the same time each day, with the client wearing similar clothing, ensures accurate and comparable measurements, providing a reliable trend of the client’s weight.

Choice A rationale

Isotretinoin is a highly effective medication for severe acne, but it is a potent human teratogen. It can cause severe birth defects, miscarriage, and premature birth if a patient becomes pregnant while taking it. The iPLEDGE program mandates two forms of contraception and monthly pregnancy tests for all female patients.

Choice B rationale

The dose of isotretinoin is carefully titrated based on the patient's weight and response to therapy. Increasing the dose without a physician's order is extremely dangerous and can lead to severe side effects such as cheilitis, xerosis, and potential liver damage. Doses are not to be altered by the patient.

Choice C rationale

There is no credible scientific evidence that the intake of specific foods like chocolate, cola, or peanuts causes or exacerbates acne. This is a common misconception. Acne pathogenesis involves sebum production, follicular hyperkeratinization, and bacterial proliferation, not dietary intake of these items.

Choice D rationale

Isotretinoin increases the skin's sensitivity to sunlight and UV radiation, a condition known as photosensitivity. This effect is due to the drug's impact on skin cell turnover and thinning of the stratum corneum. Patients are advised to limit sun exposure and use broad-spectrum sunscreens to prevent severe sunburn.