A nurse is teaching a client who has Graves' disease about recognizing the manifestations of thyroid storm. Which of the following findings should the nurse include in the teaching?
Decreased heart rate
Increased temperature
Lethargy
Hypotension
The Correct Answer is B
A) Decreased heart rate: In thyroid storm, the heart rate typically increases due to elevated levels of thyroid hormones. A decreased heart rate would not be characteristic of this condition.
B) Increased temperature: One of the hallmark signs of thyroid storm is hyperthermia or increased body temperature, often exceeding 101°F (38.3°C). This is due to the heightened metabolic state caused by excess thyroid hormones.
C) Lethargy: While lethargy can occur in other thyroid-related issues, thyroid storm is more commonly associated with hyperactivity and agitation rather than lethargy. Clients may present with restlessness and confusion.
D) Hypotension: In thyroid storm, clients often experience hypertension rather than hypotension. The increased metabolic demands can lead to elevated blood pressure due to increased cardiac output and peripheral vasodilation.
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Correct Answer is C
Explanation
A) Respiratory rate 10/min: A respiratory rate of 10 breaths per minute indicates bradypnea, which may be concerning. However, this finding is not directly associated with metoprolol. Metoprolol primarily affects heart rate and blood pressure, making this less relevant in identifying an adverse effect of the medication.
B) Blood pressure 138/76 mm Hg: This blood pressure reading is within the normal range for most individuals. While metoprolol can lower blood pressure, this value does not indicate an adverse effect, as it shows adequate control rather than a concerning reaction.
C) Heart rate 48/min: A heart rate of 48 beats per minute indicates bradycardia, a known adverse effect of beta-blockers like metoprolol. In patients with heart failure, this can lead to insufficient cardiac output and may require intervention. Thus, this finding is critical and should be addressed immediately.
D) Temperature 36.3° C (97.3° F): This temperature is within the normal range and does not indicate an adverse effect related to metoprolol. While monitoring temperature is important, it is not a direct concern regarding the use of this medication.
Correct Answer is C
Explanation
A) Generalized abdominal pain: While abdominal pain can occur with peritonitis, it is not always the earliest indication. Pain may develop after other symptoms become apparent, making it less specific as an initial sign.
B) Fever: Fever is a common symptom of infection, including peritonitis. However, it can also occur in various other conditions and may not be the first noticeable symptom, especially if the infection is localized.
C) Cloudy effluent: Cloudy or turbid dialysate effluent is often the earliest and most specific indication of peritonitis in patients undergoing peritoneal dialysis. This change in the appearance of the effluent suggests an infection, and the presence of cloudy fluid should prompt further evaluation for peritonitis.
D) Increased heart rate: An increased heart rate can be a response to various conditions, including infection, but it is not specific to peritonitis and may not be the earliest sign.