A nurse is reinforcing teaching to the parents of a school-age child about palliative care. Which of the following statements should the nurse make?

A. Atrial fibrillation on the cardiac monitor. Rheumatic fever can cause carditis, but atrial fibrillation is not a typical finding. Instead, valvular damage, tachycardia, or murmurs are more commonly observed.

B. Elevated BUN and creatinine on morning laboratory results. Rheumatic fever primarily affects the heart, joints, skin, and brain, not the kidneys. Elevated BUN and creatinine are more indicative of post-streptococcal glomerulonephritis, a separate complication of streptococcal infection.

C. Involuntary movements of extremities. Sydenham’s chorea, characterized by involuntary, jerky movements, is a classic neurologic manifestation of rheumatic fever. It results from inflammation affecting the basal ganglia of the brain.

D. Alopecia. Rheumatic fever does not cause alopecia. Hair loss is more commonly associated with autoimmune diseases such as lupus, not post-streptococcal complications.

E. Report of chest pain. Chest pain can indicate carditis, a major criterion for rheumatic fever. Inflammation of the heart's endocardium, myocardium, or pericardium may lead to pain, murmurs, or heart failure symptoms.

F. Oliguria. Decreased urine output is more commonly seen in post-streptococcal glomerulonephritis rather than rheumatic fever, as rheumatic fever primarily affects the heart, joints, and nervous system.

A. Frequent assessments of blood glucose levels. While hypothyroidism can affect metabolism, levothyroxine does not typically require frequent blood glucose monitoring unless the client has diabetes or another metabolic condition.

B. Routine monitoring of thyroid-stimulating hormone (TSH) levels. TSH is the primary indicator used to assess whether levothyroxine dosage is effective. Routine TSH monitoring ensures that thyroid hormone levels remain within the target range, preventing complications such as under-treatment (persistent hypothyroid symptoms) or over-treatment (hyperthyroid symptoms like palpitations and weight loss).

C. Regular monitoring of blood pressure. While thyroid dysfunction can affect blood pressure, routine BP monitoring is not the primary focus of hypothyroidism management unless the client has additional risk factors for hypertension.

D. Continuous monitoring of body temperature. Hypothyroidism can cause cold intolerance, but continuous body temperature monitoring is not necessary unless the client is at risk for severe hypothyroidism complications such as myxedema coma.