A nurse is caring for a client who reports increased anxiety, nervousness, heat intolerance, and unintentional weight loss. Blood testing reveals decreased thyroid-stimulating hormone (TSH), elevated thyroxine (T4), and elevated triiodothyronine (T3). Which of the following vital sign abnormalities does the nurse anticipate?

Choice A reason:

Thickening of the walls of the ventricles is not typically associated with restrictive cardiomyopathy (RCM). This condition is more characteristic of hypertrophic cardiomyopathy (HCM), where the heart muscle becomes abnormally thick, making it harder for the heart to pump blood. In RCM, the walls of the ventricles are usually not thickened but become rigid due to fibrosis or infiltration, which restricts the heart’s ability to fill with blood during diastole.

Choice B reason:

Stretching of the ventricles is more commonly seen in dilated cardiomyopathy (DCM), not restrictive cardiomyopathy. In DCM, the heart’s ventricles become enlarged and weakened, which impairs the heart’s ability to pump blood efficiently. RCM, on the other hand, involves stiffening of the ventricular walls without significant dilation.

Choice C reason:

Thickening of the ventricular walls and septum is a hallmark of hypertrophic cardiomyopathy (HCM), not restrictive cardiomyopathy. In HCM, the thickened walls can obstruct blood flow and lead to various complications. RCM is characterized by the stiffening of the ventricular walls due to fibrosis or infiltration, which restricts diastolic filling.

Choice D reason:

When the ventricular tissue becomes fibrous and fatty is the correct description of restrictive cardiomyopathy (RCM). In RCM, the heart’s ventricles become stiff and less elastic due to fibrosis (scarring) or infiltration by abnormal substances, such as amyloid proteins. This rigidity impairs the heart’s ability to fill properly during diastole, leading to symptoms of heart failure

The correct answer is a) Serum potassium levels.

Choice A reason:

Serum potassium levels are crucial to monitor in clients with hypervolemia, ketoacidosis, and metabolic acidosis. Potassium imbalances are common in these conditions due to shifts between intracellular and extracellular compartments. In diabetic ketoacidosis (DKA), for example, insulin deficiency and acidosis cause potassium to move out of cells, leading to hyperkalemia. However, once treatment with insulin begins, potassium shifts back into cells, which can cause hypokalemia. Both hyperkalemia and hypokalemia can have serious cardiac implications, making it essential to monitor and manage potassium levels closely.

Choice B reason:

Serum calcium levels are important for overall health, but they are not the primary concern in the context of hypervolemia, ketoacidosis, and metabolic acidosis. While calcium imbalances can occur, they are less common and less immediately life-threatening compared to potassium imbalances. Monitoring calcium is still necessary, but it does not require the same level of immediate intervention.

Choice C reason:

Serum sodium levels are also important to monitor, especially in conditions like hypervolemia where fluid balance is disrupted. However, sodium imbalances are typically managed through fluid management and do not pose the same immediate risk as potassium imbalances in the context of ketoacidosis and metabolic acidosis. Hyponatremia or hypernatremia can cause neurological symptoms, but these are generally less acute compared to the cardiac risks associated with potassium imbalances.

Choice D reason:

Blood urea nitrogen (BUN) levels provide information about kidney function and hydration status. Elevated BUN can indicate dehydration or renal impairment, which are relevant in the context of hypervolemia and ketoacidosis. However, BUN levels do not require the same level of immediate intervention as potassium levels. Monitoring BUN is important for overall management but is not the primary concern in acute settings.