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 the best finding to indicate that the medication is effective. Reports of increased energy levels and decreased fatigue are subjective and nonspecific signs that may reflect the client's mood, activity, or sleep quality. They may also be influenced by other factors, such as nutrition, hydration, or stress. The nurse should monitor the client's subjective symptoms, but they are not the most reliable indicators of the medication's efficacy.

Choice B reason: This is not the best finding to indicate that the medication is effective. Food diary shows increased consumption of iron-rich foods, which is a positive dietary behavior that can help improve the client's iron status and prevent iron deficiency anemia. However, iron-rich foods are not sufficient to treat the anemia caused by CKD, which is due to the reduced production of erythropoietin, a hormone that stimulates the bone marrow to make red blood cells. The nurse should encourage the client to eat a balanced diet, but it is not the main factor that determines the medication's effectiveness.

Choice C reason: This is not the best finding to indicate that the medication is effective. Takes concurrent iron therapy without adverse effects, which is a recommended adjunctive treatment that can enhance the response to epoetin alfa and increase the hemoglobin levels. However, iron therapy alone is not enough to correct the anemia caused by CKD, and it may have some side effects, such as constipation, nausea, or abdominal pain. The nurse should ensure that the client takes the prescribed dose of iron and monitors for any adverse effects, but it is not the primary outcome that measures the medication's efficacy.

Choice D reason: This is the best finding to indicate that the medication is effective. Hemoglobin level increased to 12 g/dL (7.45 mmol/L), which is within the normal range for males and indicates that the anemia has improved. Hemoglobin is the main component of red blood cells that carries oxygen to the tissues, and it is the most objective and accurate indicator of the medication's efficacy. Epoetin alfa is a synthetic form of erythropoietin that stimulates the bone marrow to produce more red blood cells and increase the hemoglobin levels. The nurse should check the hemoglobin levels regularly and report any abnormal findings to the healthcare provider.

Choice A reason: This is not the most important adverse effect for the nurse to report. Nausea is a common side effect of metoclopramide, which is a prokinetic and antiemetic drug that stimulates the motility of the upper GI tract and blocks the dopamine receptors in the chemoreceptor trigger zone. Nausea may be mild or moderate, and it may subside with time or dose adjustment. The nurse should monitor the client's nausea and provide supportive measures, such as fluids, crackers, or ginger, but it is not a priority.

Choice B reason: This is the most important adverse effect for the nurse to report. Involuntary movements, or extrapyramidal symptoms, are a serious and potentially irreversible side effect of metoclopramide, which can occur due to the blockade of the dopamine receptors in the basal ganglia. Involuntary movements can include dystonia, akathisia, parkinsonism, or tardive dyskinesia, and they can affect the face, neck, limbs, or trunk. The nurse should assess the client for any signs of involuntary movements and notify the healthcare provider immediately. The nurse should also prepare to administer an anticholinergic drug, such as benztropine, to counteract the effects of metoclopramide.

Choice C reason: This is not the most important adverse effect for the nurse to report. Unusual irritability is a rare and mild side effect of metoclopramide, which may be related to the central nervous system effects of the drug. Unusual irritability may manifest as restlessness, anxiety, or agitation, and it may resolve with time or dose adjustment. The nurse should monitor the client's mood and behavior and provide reassurance and comfort, but it is not a priority.

Choice D reason: This is not the most important adverse effect for the nurse to report. Diarrhea is a rare and mild side effect of metoclopramide, which may be related to the increased motility of the GI tract. Diarrhea may be transient or self-limiting, and it may be managed with fluids, electrolytes, or antidiarrheal drugs. The nurse should monitor the client's stool frequency and consistency and provide hydration and hygiene, but it is not a priority.