After obtaining a history and assessing a client with diabetes mellitus, the nurse can expect to see or gather information about the following clinical symptoms.

Choice A rationale: A quiet, dark environment is part of supportive care for a patient with hyperthyroidism, as it can reduce anxiety and sympathetic nervous system stimulation. However, a 1-degree Fahrenheit increase in temperature is a critical early sign of a developing thyroid storm, a life-threatening condition. This action is not the most urgent and is supportive, not a direct intervention.
Choice B rationale: An elevation in temperature, even a slight one, in a patient with Graves disease is a hallmark sign of an impending thyroid storm, a hypermetabolic state that can lead to cardiac dysrhythmias and death. An immediate ECG is crucial to assess for cardiac complications such as tachycardia, atrial fibrillation, and other life-threatening dysrhythmias that can develop rapidly in this emergency.
Choice C rationale: The apical-radial pulse deficit is a measure of the difference between the apical and radial pulse rates. While a significant deficit can indicate a dysrhythmia like atrial fibrillation, which is a concern with Graves disease, assessing the heart's electrical activity via an ECG is a more direct and immediate action to identify and manage the root cause of the cardiac instability.
Choice D rationale: Administering acetaminophen can help reduce fever, a symptom of thyroid storm. However, it does not address the underlying hypermetabolic state or the critical cardiac complications that are the primary danger. It is not the first or most critical action, as a full cardiac assessment via ECG is paramount to guide definitive treatment and prevent a fatal outcome.

Choice A rationale: Thyroid hormone absorption is enhanced when taken on an empty stomach, typically in the morning approximately 30-60 minutes before breakfast. Food, particularly calcium, iron, and soy, can chelate with the medication and reduce its bioavailability, leading to inadequate therapeutic levels. This timing ensures consistent and maximal drug absorption, preventing erratic serum hormone levels and optimizing symptom control.
Choice B rationale: Taking thyroid medication with a meal, such as lunch, significantly impedes its absorption. The presence of food in the gastrointestinal tract, especially high-fiber foods, binds to the synthetic hormone, reducing the amount available for systemic circulation. This can lead to sub-therapeutic levels, resulting in persistent hypothyroid symptoms like fatigue, weight gain, and cold intolerance.
Choice C rationale: Administering thyroid replacement therapy with the evening meal is not recommended due to reduced absorption efficacy. The stomach's pH and motility are altered by food consumption, which can interfere with the dissolution and absorption of the drug. Consistent poor absorption can necessitate dosage increases, complicating medication management and potentially leading to adverse effects.
Choice D rationale: Taking thyroid medication at bedtime is generally discouraged because it can cause insomnia and interfere with sleep patterns. The increase in metabolic rate induced by the hormone can make it difficult for some individuals to fall asleep. Additionally, absorption may still be compromised if the individual has recently eaten, as gastric emptying is slower during sleep.