A nurse is caring for a client who has Graves' disease. Which of the following findings should indicate to the nurse that the client is developing a thyroid storm?
Tachycardia
Hypotension
Neck pain
Respiratory depression
The Correct Answer is A
A. Tachycardia: This is correct. Tachycardia is one of the hallmark signs of thyroid storm, a life-threatening complication of hyperthyroidism (often seen in Graves' disease.. The excessive thyroid hormone leads to severe metabolic disturbances, including an increased heart rate.
B. Hypotension: Hypotension is not typically a feature of thyroid storm. In fact, thyroid storm is more commonly associated with hypertension due to the increased heart rate and metabolic activity.
C. Neck pain: Neck pain is not a common symptom of thyroid storm. Neck pain might be related to other conditions, such as thyroiditis or a goiter, but not specifically thyroid storm.
D. Respiratory depression: Respiratory depression is not a typical symptom of thyroid storm. On the contrary, thyroid storm often leads to symptoms like hyperventilation, not depressed breathing.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. "Take the medication and then lay down for 30 min.": This is not recommended. Lying down after taking doxycycline can increase the risk of esophageal irritation and ulceration. It is best to remain upright for at least 30 minutes after taking the medication.
B. "Take the medication with an antacid.": This is incorrect. Antacids can interfere with the absorption of doxycycline and reduce its effectiveness. It is important to avoid antacids, calcium supplements, and iron supplements within 2 hours of taking doxycycline.
C. "Take the medication with calcium-fortified orange juice.": This is incorrect. Calcium can bind with doxycycline, reducing its absorption and effectiveness. It is best to avoid taking doxycycline with calcium-rich products like milk or fortified juices.
D. "Take the medication with crackers.": This is correct. Taking doxycycline with a small amount of food, like crackers, can help reduce gastrointestinal discomfort, such as nausea and vomiting. It is recommended to take doxycycline with food if nausea occurs, though not with dairy or antacids.
Correct Answer is C
Explanation
A. Elevated blood pressure: Diabetic ketoacidosis (DKA. typically does not cause elevated blood pressure. In fact, due to dehydration from increased urination, clients often present with hypotension or normal blood pressure, rather than hypertension.
B. Bounding pulse: A bounding pulse is not commonly associated with DKA. It may be seen with conditions such as fever or sepsis, but DKA is more likely to cause a weak or thready pulse due to fluid volume deficit and dehydration.
C. Fruity breath odor: A fruity or acetone-like breath odor is a hallmark sign of diabetic ketoacidosis. This is caused by the presence of ketones in the blood, which are produced as the body breaks down fat for energy when glucose is unavailable.
D. Clammy skin: Clammy skin is more likely to be associated with hypoglycemia, not DKA. In DKA, the skin is typically dry due to dehydration, and the client may appear flushed, not clammy.
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