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?
Increased temperature
Lethargy
Decreased heart rate
Hypotension
The Correct Answer is A
A Hyperthermia is a hallmark sign of thyroid storm due to the body's increased metabolic rate and inability to dissipate heat efficiently. High fever is a critical sign that should prompt immediate medical evaluation and treatment.
B. While fatigue and lethargy can occur in hyperthyroidism, they are not prominent features of thyroid storm. Individuals with thyroid storm typically exhibit agitation, restlessness, or even delirium due to the effects of excessive thyroid hormone on the central nervous system.
C. Bradycardia is not a feature of thyroid storm. Instead, individuals typically experience severe tachycardia, which can lead to palpitations, chest pain, and cardiovascular complications.
D. Thyroid storm is more commonly associated with hypertension rather than hypotension. Increased cardiac output and vascular resistance contribute to elevated blood pressure during thyroid storm.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["C"]
Explanation
A To obtain reliable results, it is generally recommended to collect samples from different areas of the stool across multiple bowel movements rather than from a single sample.
detecting occult blood if it is present in the stool but not evenly distributed throughout. It also helps to reduce the chance of obtaining a false negative result.
C. Urine can interfere with the accuracy of fecal occult blood testing, leading to false positive results. Therefore, any sample that contains visible urine should be discarded to prevent inaccurate test results.
B. While gloves should be worn to maintain standard precautions and prevent direct contact with feces, sterile gloves are not required for this procedure. Standard medical examination gloves are sufficient to ensure hygiene and prevent contamination during sample collection.
D. The guaiac smear should be performed on a small portion of stool obtained from different areas within the bowel movement, not specifically from the outer edge of formed stool. The goal is to sample from different parts to increase the likelihood of detecting any occult blood present.
Correct Answer is A
Explanation
A Pertussis is highly contagious and spread through respiratory droplets. Wearing a surgical mask when providing care to the client helps prevent the spread of the bacteria to others in the healthcare setting. This is a standard precaution to minimize transmission of respiratory infections.
B. A Mantoux test, or tuberculin skin test, is used to detect tuberculosis (TB) infection, not pertussis. It is not relevant to the diagnosis or management of pertussis. The focus should be on clinical assessment and appropriate treatment for pertussis.
C Pertussis does not typically require isolation in a negative pressure airflow room. Standard precautions, including wearing a surgical mask, are generally sufficient to prevent transmission. Negative pressure rooms are typically reserved for airborne infections like tuberculosis or measles.
D. Pertussis is caused by a bacterial infection (Bordetella pertussis), not a virus. Antiviral therapy is not effective against bacterial infections such as pertussis. Family members and close contacts of the client should receive prophylactic antibiotics to prevent spread of the infection, not antiviral therapy.
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