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 A
Explanation
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B) Take the sample from the outer edge of formed stool: While it is important to collect from a clean area, the preferred method is to take samples from different areas of the stool, not just the outer edge, to ensure representative testing.
C) Wear sterile gloves when collecting the sample: While wearing gloves is important for infection control, non-sterile gloves are typically sufficient for this type of procedure. The focus should be on avoiding contamination of the sample rather than sterility.
D) Collect three samples from a single bowel movement: This statement is incorrect; the standard practice is to collect samples from three different bowel movements on different days, rather than multiple samples from a single event, to increase the reliability of the test results.
Correct Answer is C
Explanation
Diphenhydramine: This is an antihistamine primarily used to treat allergies and as a sedative. It is not indicated for reversing opioid-induced respiratory depression and could potentially worsen the sedation.
Flumazenil: This medication is a benzodiazepine antagonist and is used to reverse the effects of benzodiazepines. It is not effective for opioid overdose or respiratory depression caused by morphine.
Naloxone: Naloxone is an opioid antagonist used to reverse the effects of opioid overdose, including respiratory depression. In cases of opioid-induced respiratory depression, naloxone is the appropriate medication to administer to restore normal respiratory function.
Calcium gluconate: This medication is used for conditions such as hypocalcemia or magnesium toxicity, but it is not relevant for opioid overdose or respiratory depression.