The nurse observes that a client has become lethargic 30 minutes after receiving an opioid injection for pain. Which vital sign should the nurse obtain first?

A. Before meals to prevent hyperglycemia: Glucagon is not used to prevent hyperglycemia. Instead, it is used in emergency situations to address severe hypoglycemia. Preventing hyperglycemia is typically managed with insulin and other diabetes management strategies, not glucagon.
B. When unable to eat during sick days: While it is important to manage blood glucose levels when unable to eat, glucagon is specifically used for severe hypoglycemia rather than during periods of illness where eating is difficult. During sick days, other measures, such as adjusting insulin or seeking medical advice, are more appropriate.
C. When signs of severe hypoglycemia occur: This is the correct instruction. Glucagon is an emergency treatment used to rapidly raise blood glucose levels in cases of severe hypoglycemia where the person is unconscious or unable to take oral glucose. Recognizing and administering glucagon during severe hypoglycemic episodes is crucial for preventing complications.
D. At the onset of signs of diabetic ketoacidosis: Glucagon is not used to treat diabetic ketoacidosis (DKA). DKA is managed with insulin, fluids, and electrolytes. Glucagon is specifically for severe hypoglycemia and is not indicated for DKA.

A) When using the discus, have the client breathe out rapidly into the mouthpiece: This instruction is incorrect because the client should not breathe out into the discus mouthpiece. Exhaling into the device could result in moisture entering the discus, which may cause the medication powder to clump, reducing the dose received and potentially making the device unusable.
B) Offer the discus to the client for use during an acute asthma attack: This is not appropriate because fluticasone and salmeterol discus is not a rescue inhaler. It is a long-acting bronchodilator and corticosteroid combination meant for maintenance therapy, not for quick relief during an acute asthma attack. Short-acting bronchodilators like albuterol are used for immediate relief.
C) Clients using the discus may experience decreased blood pressure: There is no known association between the use of the fluticasone/salmeterol discus and decreased blood pressure. The primary side effects associated with this medication include potential respiratory effects, such as throat irritation, and not systemic cardiovascular effects like low blood pressure.
D) Explain that the client should not use the discus more than twice daily: This is the correct instruction because the fluticasone/salmeterol combination is designed for maintenance therapy and should not be used more than twice daily. Overuse can increase the risk of side effects, such as oral thrush, hoarseness, or more serious systemic effects from the corticosteroid and long-acting beta-agonist components.