In managing a patient experiencing thyroid storm, which of the following interventions should the nurse prioritize? Select all that apply.

Rationale:

A. Prescribing 100 mg of oxymorphone for a patient who was previously receiving 1 mg would be an extremely dangerous overdose, potentially causing severe respiratory depression, sedation, coma, or death. This dose does not align with equianalgesic principles, which rely on maintaining continuity of analgesic effect.

B. Similarly, prescribing 75 mg represents a dramatic increase over the previous effective dose. Equianalgesic dosing is intended to ensure comparable pain control, and a 75-fold increase is unsafe and medically inappropriate.

C. The patient was receiving 1 mg of oxymorphone prior to discharge. To maintain pain control and prevent withdrawal, the same dose should be continued unless clinical factors, such as breakthrough pain, side effects, or changes in pain severity, warrant an adjustment. Maintaining the current dose ensures stable analgesia and prevents withdrawal symptoms, which can include agitation, anxiety, sweating, nausea, vomiting, abdominal cramps, and muscle aches. Continuity of opioid therapy is critical in avoiding these potentially distressing symptoms.

D. Prescribing 10 mg represents a tenfold increase, which is extremely unsafe and not supported by equianalgesic dosing guidelines for a patient previously on 1 mg. Such a dose could result in life-threatening respiratory depression or opioid toxicity.

Rationale:

A. Hyperparathyroidism, whether primary (due to parathyroid adenoma, hyperplasia, or carcinoma) or secondary (commonly related to chronic kidney disease), does not resolve spontaneously. Without appropriate management, persistent elevated parathyroid hormone (PTH) levels can lead to chronic hypercalcemia, kidney stones, bone demineralization (osteopenia/osteoporosis), and cardiovascular complications. Telling the patient it will resolve on its own is misleading and can delay necessary interventions.

B. Adequate hydration is a primary preventive measure in hyperparathyroidism. High calcium levels increase renal calcium excretion but can also promote calcium stone formation if fluid intake is insufficient. Drinking 2–3 liters of water daily, unless contraindicated, helps dilute urinary calcium and reduce the risk of kidney stones. Hydration also helps prevent the dehydration that often accompanies hypercalcemia due to polyuria.

C. Hypercalcemia can cause polyuria, nausea, vomiting, and weakness, all of which increase the risk of dehydration. The nurse should assess skin turgor, mucous membranes, blood pressure, heart rate, and daily weight to detect fluid loss early. Timely detection allows for prompt interventions such as oral or IV fluid replacement, reducing complications such as hypotension or acute kidney injury.

D. Laboratory monitoring is essential for tracking disease progression and evaluating treatment effectiveness. Key labs include serum calcium, phosphate, PTH, creatinine, and 25-hydroxy vitamin D levels. Frequent monitoring allows clinicians to adjust interventions, such as recommending surgery or pharmacologic treatment (e.g., bisphosphonates or calcimimetics), before severe complications occur.

E. These foods are high in calcium, which can exacerbate hypercalcemia in patients with hyperparathyroidism. Dietary calcium restriction is often advised to prevent further elevation of serum calcium levels, although strict restriction is usually balanced with maintaining adequate calcium for bone health.

F. Calcium supplements are generally avoided in hyperparathyroidism unless the patient has undergone parathyroidectomy and is at risk for hypocalcemia. Unmonitored supplementation can worsen hypercalcemia and increase the risk of kidney stones and cardiovascular complications.

G. In primary hyperparathyroidism, PTH increases calcium reabsorption and phosphate excretion, leading to hypophosphatemia. Encouraging foods higher in phosphorus (e.g., meat, poultry, fish, eggs, and some whole grains) can help balance calcium-phosphate levels, reduce hypercalcemia complications, and support bone health.

H. While high-impact activity or excessive strain should be avoided due to bone fragility, complete inactivity is not recommended. Moderate weight-bearing exercise helps maintain bone density, prevent muscle loss, and support overall cardiovascular health. Limiting all activity could worsen osteopenia, muscle weakness, and functional decline.