A nurse is reinforcing teaching with a child and her parents who has a growth hormone deficiency. Which of the following complications of untreated growth hormone deficiency should the nurse include? (Select all that apply.)

A. Patchy hair loss can result from excessive scratching, secondary bacterial infection, or other scalp disorders (for example, tinea capitis or alopecia areata). While lice-related scratching can contribute to hair breakage or localized hair loss, hair loss alone is not diagnostic of pediculosis capitis and requires further inspection.

B. Intense pruritus is a common symptom of head lice because the host mounts an allergic response to louse saliva. However, itching is nonspecific, many scalp conditions (dandruff, eczema, fungal infections, dermatitis) cause itching, so it cannot definitively establish the diagnosis by itself.

C. These findings are characteristic of secondary bacterial infection of the skin, such as impetigo, not of an uncomplicated lice infestation. Although scratching from lice can lead to skin breakdown and secondary infection, crusted, purulent lesions indicate infection that needs separate treatment and are not the hallmark of pediculosis capitis.

D. The presence of nits (lice eggs) attached firmly to the hair shaft near the scalp is the definitive sign of pediculosis capitis. Nits do not flake off like dandruff and are the key diagnostic indicator.

A. Isotretinoin does not typically alter potassium levels. Routine monitoring of potassium is not indicated in healthy adolescents taking isotretinoin, as the medication does not have known effects on renal potassium handling or cause electrolyte imbalances in this context. Monitoring potassium is only relevant if the patient has other conditions or medications that affect electrolytes.

B. Isotretinoin can cause hyperlipidemia, increasing cholesterol and triglyceride levels, which may raise the risk for pancreatitis or long-term cardiovascular issues. Baseline lipid panels are obtained before starting therapy, with periodic monitoring during treatment to detect and manage elevations promptly.

C. Isotretinoin is not nephrotoxic, meaning it does not typically impair kidney function. Routine monitoring of BUN and creatinine is not necessary unless the adolescent has preexisting kidney disease or other risk factors. Focus should remain on labs directly affected by the medication.

D. Isotretinoin has no significant impact on serum sodium levels. Hyponatremia is not a known complication of isotretinoin therapy, so routine sodium monitoring is unnecessary in otherwise healthy clients. Laboratory monitoring should prioritize liver function tests and lipid profiles, which are more likely to be affected.