After administering oral doses of calcitriol and calcium carbonate to a client with hypoparathyroidism, the nurse notes that the client's total calcium level is 14 mg/dL (3.5 mmol/L). Which action should the nurse implement?

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: A yellow skin color may indicate jaundice, which is a sign of liver damage. Acetaminophen can cause liver toxicity, especially in high doses or with chronic use. The nurse should report this finding to the healthcare provider as soon as possible, as it may require further evaluation and treatment.

Choice B reason: Checking the client's capillary glucose level is not relevant to the finding of yellow skin color. Although diabetes can cause skin changes, such as dryness or infections, it does not cause jaundice. The nurse should focus on the potential liver problem rather than the blood sugar level.

Choice C reason: Using a pulse oximeter to assess oxygen saturation is not helpful in this situation. A low oxygen saturation may indicate hypoxia, which can affect various organs, but it does not cause jaundice. The nurse should monitor the client's respiratory status, but it is not the priority action in response to the yellow skin color.

Choice D reason: Advising the client to reduce the medication dose is not appropriate without consulting the healthcare provider. The client may need acetaminophen for pain relief, and reducing the dose may not be enough to prevent liver damage. The nurse should not make any changes to the medication regimen without the provider's order.