The nurse is assessing a client suspected of having thyroid storm. Which finding would be of immediate concern and require prompt intervention?
Diarrhea
Restlessness
Increased appetite
Muscle weakness
The Correct Answer is B
Restlessness and agitation are signs of increased sympathetic nervous system activity and can indicate the severity of thyroid storm. Prompt intervention is required to prevent further deterioration.
Incorrect choices:
a. This choice is incorrect. Diarrhea can be a symptom of thyroid storm, but it is not an immediate concern that requires urgent intervention.
c. This choice is incorrect. Increased appetite is not a characteristic feature of thyroid storm. In fact, clients with thyroid storm often have decreased appetite due to the severity of their condition.
d. This choice is incorrect. Muscle weakness is a symptom of hyperthyroidism but is not an immediate concern that requires urgent intervention.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Hyperventilation, or rapid and deep breathing, is a respiratory manifestation commonly observed in clients with thyroid storm. The increased metabolic rate and elevated body temperature contribute to respiratory alkalosis and hyperventilation.
Incorrect choices:
a. Bradypnea, or slow breathing, is not a characteristic respiratory manifestation of thyroid storm.
c. Wheezing is not commonly associated with thyroid storm and is more indicative of respiratory conditions such as asthma.
d. Decreased respiratory rate is not a typical manifestation of thyroid storm, as clients often experience rapid breathing due to the hypermetabolic state.
Correct Answer is A
Explanation
Administering antithyroid medications, such as propylthiouracil (PTU) or methimazole, is a priority in managing thyroid storm. These medications inhibit the production of thyroid hormones and help control the hyperthyroid state.
Incorrect choices:
b. Initiating high-dose thyroid hormone replacement therapy is not appropriate for thyroid storm, as the goal is to reduce thyroid hormone levels, not increase them.
c. While intravenous fluid resuscitation may be necessary to manage dehydration and electrolyte imbalances associated with thyroid storm, it is not the initial priority intervention.
d. Encouraging physical activity is contraindicated in thyroid storm, as it can exacerbate symptoms and increase the risk of complications.
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