A nurse is teaching a group of clients who plan to receive the human papillomavirus (HPV) Immunization. Which of the following statements by a group member indicates an understanding of the teaching?

Rationale for correct choices:

• Hyperthyroidism: The client presents with classic signs of hyperthyroidism or thyroid storm: heat intolerance, tremors, tachycardia, palpitations, agitation, insomnia, weight loss despite good appetite, diarrhea, and recent illness (influenza) acting as a trigger. These symptoms indicate an acutely increased metabolic state.
• Place client on telemetry: Tachycardia and palpitations suggest cardiac involvement. Continuous cardiac monitoring helps detect life-threatening arrhythmias, such as atrial fibrillation, which are common in hyperthyroid crises.
• Initiate hydration therapy: Hypermetabolism, fever, and diarrhea can cause fluid loss and increase the risk for dehydration. Hydration supports perfusion and reduces cardiac strain during a hypermetabolic state.
• Cardiac dysrhythmias: Excess thyroid hormones increase the heart's sensitivity to catecholamines, heightening the risk for dysrhythmias. Monitoring rhythm helps identify complications early.
• Neurological status: Agitation, tremors, and insomnia may progress to delirium or seizures in thyroid storm. Regular neuro checks allow early recognition of worsening symptoms.

Rationale for incorrect choices:

• Hypoparathyroidism: This typically presents with signs of hypocalcemia such as tetany or paresthesias, not the metabolic hyperactivity seen here. The client's symptoms do not reflect this condition.
• Hyperparathyroidism: It usually causes hypercalcemia, bone pain, and kidney stones, none of which are evident. Diarrhea, fever, and cardiac signs are not typical.
• Hypothyroidism: Presents with fatigue, cold intolerance, constipation, bradycardia, and weight gain—opposite of this client’s hyperactive symptoms.
• Check for Chvostek and Trousseau’s signs: These are used to assess for hypocalcemia, which is not indicated in this scenario. There are no neuromuscular irritability symptoms present.
• Monitor for hypoglycemia: There's no indication of low blood sugar, and the client does not report symptoms like shakiness, confusion, or hunger related to hypoglycemia.
• Provide nutritional support: While the client has lost weight, the priority is stabilizing the acute condition (thyroid storm), not nutritional rehabilitation at this moment.
• Phosphorus levels: These are not directly affected in hyperthyroidism and monitoring them wouldn't provide information relevant to the current crisis.
• Weight gain: This client has experienced weight loss, and tracking weight gain is not a relevant short-term indicator of improvement in acute hyperthyroidism.
• Calcium levels: There is no evidence of calcium imbalance or parathyroid involvement, so monitoring calcium is not pertinent in this case.

A. Increased joint pain: Joint pain is not a typical sign of overexposure to phototherapy. While psoriatic arthritis can occur in individuals with psoriasis, it is not directly linked to phototherapy overexposure.

B. Increased body temperature: While phototherapy may slightly raise the body's temperature, a significant increase in body temperature is not a typical indication of overexposure. This could suggest another underlying issue, such as infection or heatstroke.

C. Cool, moist extremities: Cool, moist extremities are not typically associated with phototherapy overexposure. This finding is more indicative of circulatory or other systemic issues, which do not directly result from phototherapy.

D. Small blisters on the skin: Small blisters on the skin are a common sign of overexposure to phototherapy. Phototherapy uses ultraviolet (UV) light, and excessive exposure can lead to skin damage, including burns or blisters, similar to sunburn.