A nurse is assessing a patient with Grave's disease. Which finding requires immediate attention?

Choice A rationale: The initial administration of a half-cup of orange juice, which contains simple carbohydrates, is the correct first step for a conscious patient experiencing hypoglycemia. Since the client's symptoms persist after five minutes, it's necessary to provide another dose of a fast-acting carbohydrate to raise the blood glucose level. A second dose is warranted before escalating to more aggressive treatments.
Choice B rationale: Dextrose 50% intravenous administration is reserved for severe hypoglycemia in clients who are unconscious, unable to swallow, or who have not responded to oral carbohydrate therapy. Administering it to an alert and conscious patient is not the first-line intervention and can cause rebound hypoglycemia if not carefully managed, so it's not the next step.
Choice C rationale: Administering insulin would be contraindicated as the client is exhibiting signs of hypoglycemia (low blood glucose). Insulin would further lower the blood glucose levels, worsening the client's condition and potentially leading to a hypoglycemic coma or seizures. It is used to lower high blood glucose levels, not for low levels.
Choice D rationale: Glucagon is a hormone that raises blood glucose by stimulating the liver to release stored glucose (glycogenolysis). It is primarily used for severe hypoglycemia in unconscious patients or those who cannot receive oral glucose. It is not the next step for an alert and conscious patient who can still take oral carbohydrates.

Choice A rationale: The described symptoms—diaphoresis, palpitations, nervousness, and tachycardia—are classic signs of hypoglycemia, or low blood glucose. These symptoms are caused by the release of counter-regulatory hormones like epinephrine and cortisol. The first appropriate action is to check the blood glucose level to confirm hypoglycemia and then administer carbohydrates to rapidly raise it back to a safe range.
Choice B rationale: Giving nitroglycerin and performing an electrocardiogram are interventions for cardiac issues, such as angina or myocardial infarction. While palpitations and tachycardia are present, they are secondary to the hypoglycemia-induced stress response, not a primary cardiac event. Addressing the underlying hypoglycemia is the priority, as these cardiac symptoms are a direct physiological consequence of the low blood sugar.
Choice C rationale: Checking pulse oximetry and administering oxygen are interventions for respiratory compromise or hypoxemia. The client's symptoms are not indicative of an issue with oxygenation. Although the body is under stress, the primary problem is a metabolic imbalance, specifically low blood glucose. Providing oxygen would not correct the underlying physiological cause of the symptoms.
Choice D rationale: Restricting salt, administering diuretics, and performing paracentesis are treatments for fluid overload, ascites, and conditions like congestive heart failure or severe liver disease. The client's symptoms are not consistent with these conditions. These interventions would be inappropriate and could be harmful, as they do not address the metabolic derangement causing the hypoglycemia.