The nurse is caring for a school-age child with hyperthyroidism (Graves’ disease). Which clinical manifestations should the nurse monitor that may indicate a thyroid storm? (Select all that apply)

Choice A reason:

Rye and oats: Rye contains gluten, which must be avoided by individuals with celiac disease. Oats, while naturally gluten-free, can often be contaminated with gluten during processing. Therefore, they should be introduced cautiously and only if labeled gluten-free.

Choice B Reason:

Wheat and corn: Wheat is a major source of gluten and must be strictly avoided by those with celiac disease. Corn, on the other hand, is naturally gluten-free and safe for consumption. However, since wheat is included in this option, it is not suitable for a gluten-free diet.

Choice C Reason:

Rice and soy: Both rice and soy are naturally gluten-free and safe for individuals with celiac disease. They are excellent alternatives to gluten-containing grains and provide essential nutrients.

Choice D Reason:

Barley and millet grain: Barley contains gluten and must be avoided by those with celiac disease. Millet is naturally gluten-free and safe for consumption. However, since barley is included in this option, it is not suitable for a gluten-free diet.

The correct answer is d) Central nervous system.

Choice A reason:

The musculoskeletal system is not primarily affected by abnormal phenylalanine levels. Phenylketonuria (PKU) is a metabolic disorder that primarily impacts the brain and cognitive functions. While muscle weakness can occur due to overall health deterioration, it is not the primary system affected by phenylalanine toxicity.

Choice B reason:

The renal system is not the main target of phenylalanine toxicity. Although the kidneys play a role in filtering blood and excreting waste, the toxic effects of phenylalanine accumulation are more pronounced in the brain. Therefore, the renal system is not the primary system affected by abnormal phenylalanine levels.

Choice C reason:

The GI system, or gastrointestinal system, is not the primary system affected by abnormal phenylalanine levels. While dietary management is crucial for individuals with PKU to control phenylalanine intake, the toxic effects are primarily seen in the brain. The GI system is involved in the absorption and digestion of nutrients, but it is not the main system impacted by phenylalanine toxicity.

Choice D reason:

The central nervous system (CNS) is the primary system affected by abnormal phenylalanine levels. Phenylketonuria (PKU) leads to the accumulation of phenylalanine in the brain, causing severe brain damage and cognitive impairments. High levels of phenylalanine can disrupt neurotransmitter synthesis and brain development, leading to intellectual disabilities and other neurological issues. Therefore, the CNS is the main system impacted by phenylalanine toxicity.