The mother of an adolescent male tells the clinic nurse that she found anabolic steroids in her son's room. How should the nurse respond? Select all that apply.

A. Start the second course of therapy after an 8-week delay: While a second course of isotretinoin may sometimes be considered after a break if acne persists, this timing is medication management guidance and is less urgent than immediate safety concerns like sun sensitivity.

B. Consider an alternative summer job, other than life guarding: Isotretinoin causes extreme photosensitivity, making prolonged sun exposure dangerous. Adolescents working outdoors, like lifeguards, are at high risk for severe sunburns, so suggesting alternative employment protects their health.

C. Store the medicine in a plastic, tight, light resistant container: Proper medication storage is important but not the most critical concern compared to preventing serious adverse effects like sunburn, teratogenicity, or psychiatric symptoms with isotretinoin use.

D. Discontinue all multivitamins during acne medication therapy: There is generally no need to discontinue all multivitamins while taking isotretinoin unless specifically instructed by the healthcare provider. Some multivitamins contain vitamin A, excessive intake of vitamin A should be avoided. However, discontinuing all multivitamins without guidance could lead to other nutritional deficiencies.

A. Contact the healthcare provider (HCP) immediately if suicidal thoughts occur: Antidepressants like sertraline can increase the risk of suicidal thoughts, especially during the early stages of treatment. Immediate reporting of such thoughts is critical to ensure the client’s safety and prevent harm.

B. Contact the healthcare provider (HCP) immediately if muscle stiffness occurs: Although rare, muscle stiffness could signal serotonin syndrome if occurs with a constellation of symptoms including confusion, agitation, fever, sweating and tremors, not just stiffness. Suicidal ideation presents a more immediate and life-threatening risk in clients starting antidepressants and requires the highest priority.

C. Increase activity level to include a daily exercise routine: While exercise is beneficial for managing depression, it is supportive therapy and not the most urgent teaching point compared to recognizing and reporting suicidal ideation associated with antidepressant use.

D. Avoid processed meats, red wine, and Swiss cheese: This dietary restriction is necessary when taking monoamine oxidase inhibitors (MAOIs) to prevent hypertensive crises. Sertraline is a selective serotonin reuptake inhibitor (SSRI), so these dietary precautions are not required.