What is an appropriate nursing approach when an adolescent on antipsychotics develops gynecomastia?

• A. Suggest cessation of therapy
• B. Encourage discussion with clinician about management options
• C. Ignore the issue
• D. Suggest cosmetic surgery immediately

Answer: (B)

When gynecomastia appears in an adolescent taking antipsychotics, the best nursing approach is to involve the clinician and discuss management options openly. This side effect is often due to elevated prolactin from dopamine D2 receptor blockade in the tuberoinfundibular pathway. For teens, this can be distressing and affect body image, so addressing it promptly and collaboratively is important.

Acknowledge the teen’s concern, gather relevant details (onset and duration of breast development, any tenderness or discharge, and how it’s affecting daily life), and review other possible contributors (other medications or medical conditions). Then, together with the clinician, explore options such as adjusting the antipsychotic dose if feasible, switching to a prolactin-sparing antipsychotic (for example, aripiprazole or others with lower prolactin risk), or adding a treatment to lower prolactin. Changes should be made under medical supervision, and the clinician can guide expectations about how quickly changes might reduce symptoms and whether additional approaches (including, in rare cases, surgical evaluation) are appropriate.