The healthcare provider (HCP) prescribes pantoprazole for a client who experienced partial and full thickness burns. The client is questioning the nurse if this medication is necessary. Which action(s) should the nurse implement? Select all that apply.

A. Hemoglobin level increased to 12 g/dL (7.45 mmol/L): Epoetin alfa stimulates red blood cell production, and an increase in hemoglobin is the primary indicator of the drug’s effectiveness. A hemoglobin of 12 g/dL reflects a significant therapeutic improvement in anemia management for a client with CKD.

B. Reports of increased energy levels and decreased fatigue: Although feeling more energetic is a positive clinical sign, it is subjective and does not provide objective evidence of improved red blood cell production. Lab values are preferred for evaluating medication effectiveness.

C. Food diary shows increased consumption of iron-rich foods: Dietary improvements support erythropoiesis but are not the direct measure of epoetin alfa’s effect. The medication’s success is best gauged by the actual rise in hemoglobin, not dietary habits alone.

D. Takes concurrent iron therapy without adverse effects: Iron supplementation is often needed to maximize epoetin alfa’s effect, but merely tolerating iron therapy does not confirm that epoetin alfa is working to correct the anemia. The focus remains on hemoglobin response.

Oral carbohydrates: The client is not currently hypoglycemic; in fact, the blood glucose is elevated at 279 mg/dL. Oral carbohydrates are typically given to treat low blood glucose, not high glucose. Administering carbohydrates here would worsen hyperglycemia.

Insulin lispro: The client’s blood glucose is significantly elevated and requires correction. Insulin lispro is a rapid-acting insulin designed to lower high blood glucose quickly, making it the correct medication to administer while monitoring closely for improvement.

Insulin glargine: Although the client is prescribed insulin glargine once daily, she has already received her dose earlier this morning before surgery. Giving another dose now would risk insulin stacking and dangerous hypoglycemia later, so it is not safe to administer at this point.

A bolus of IV fluids: The client is showing signs of early dehydration — thirst and low urine output — likely due to hyperglycemia-induced osmotic diuresis. Administering a bolus of IV fluids will help restore circulating volume, prevent further dehydration, and support tissue perfusion.