A glucagon emergency kit is prescribed for a client with type 1 diabetes mellitus to be used at home. When should the nurse instruct the client and family that glucagon needs to be administered?

Choice A reason: This is not a correct action for the nurse to include in this client's plan of care. Administering sucralfate once a day, preferably at bedtime, is not the recommended dosage or timing for this medication. Sucralfate is a mucosal protectant that forms a protective barrier over the ulcer and prevents further damage from acid and pepsin. It should be taken four times a day, one hour before meals and at bedtime, to ensure optimal coverage and healing of the ulcer.

Choice B reason: This is the correct action for the nurse to include in this client's plan of care. Giving sucralfate on an empty stomach is essential for the effectiveness of this medication. Sucralfate needs an acidic environment to activate and form a complex with the ulcer site. If the client takes sucralfate with food or beverages, the pH of the stomach may increase and reduce the ability of sucralfate to bind to the ulcer. The client should take sucralfate one hour before meals and at bedtime, and avoid antacids within 30 minutes of taking sucralfate.

Choice C reason: This is not a correct action for the nurse to include in this client's plan of care. Monitoring for electrolyte imbalance is not a specific or relevant intervention for this medication. Sucralfate does not affect the electrolyte levels in the blood, as it is not absorbed systemically and does not alter the renal function. The nurse should monitor the electrolyte levels for other reasons, such as dehydration, vomiting, or diuretic use, but not because of sucralfate therapy.

Choice D reason: This is not a correct action for the nurse to include in this client's plan of care. Assessing for secondary Candida infection is not a common or necessary intervention for this medication. Sucralfate does not increase the risk of fungal infections, as it does not suppress the immune system or alter the normal flora of the GI tract. The nurse should assess for signs of infection, such as fever, leukocytosis, or purulent drainage, for other reasons, such as perforation, abscess, or sepsis, but not because of sucralfate therapy.

Choice A reason: Performing a neurological exam is not the priority action in this situation. Confusion and blurred vision are signs of hypoglycemia, which is a low blood sugar level. Glipizide is a medication that lowers blood sugar by stimulating the pancreas to produce more insulin. The nurse should first confirm the blood sugar level before performing any other assessments or interventions.

Choice B reason: Obtaining a fingerstick blood glucose is the best action in this situation. This is a quick and easy way to measure the blood sugar level and determine if the client is experiencing hypoglycemia. The nurse should use a glucometer and a lancet to prick the client's finger and obtain a drop of blood. The nurse should compare the result with the normal range and follow the hypoglycemia protocol.

Choice C reason: Administering glucagon intramuscularly is not the first action in this situation. Glucagon is a hormone that raises blood sugar by stimulating the breakdown of glycogen in the liver. It is used as an emergency treatment for severe hypoglycemia, when the client is unconscious or unable to swallow. The nurse should only administer glucagon after confirming the blood sugar level and trying oral glucose first.

Choice D reason: Measuring the client's vital signs is not the priority action in this situation. Vital signs include blood pressure, pulse, respiration, and temperature. They can provide information about the client's overall health and stability, but they are not specific to hypoglycemia. The nurse should focus on the blood sugar level, which is the most relevant indicator of hypoglycemia.