The nurse is caring for a client who is admitted with a diagnosis of a thyroid storm. Which of the following orders would the nurse question?

Choice A reason: Fluid restriction doesn’t address hyperkalemia (6.4 mEq/L); it may concentrate potassium further, worsening the condition, as it’s unrelated to potassium excretion or shifting in this scenario.

Choice B reason: Neomycin, an antibiotic, reduces gut bacteria but isn’t used for hyperkalemia. It has no direct effect on potassium levels, making it irrelevant for this lab finding.

Choice C reason: Kayexalate binds potassium in the gut, facilitating its fecal excretion, effectively lowering serum levels (6.4 mEq/L) in hyperkalemia, aligning with urgent correction needs here.

Choice D reason: Sodium chloride and furosemide dilute and excrete potassium via urine, but Kayexalate is preferred for rapid gut-based removal when potassium is critically high (6.4 mEq/L).

Choice A reason: Tachypnea occurs in left-sided heart failure as pulmonary edema from backpressure increases respiratory effort to oxygenate blood through fluid-filled alveoli.

Choice B reason: Cough in left-sided failure results from pulmonary congestion irritating airways, often producing frothy sputum as fluid leaks from capillaries into lungs.

Choice C reason: Jugular vein distention indicates right-sided heart failure, where systemic venous pressure rises, not left-sided, which affects lungs, not neck veins.

Choice D reason: Ascites, abdominal fluid buildup, stems from right-sided failure’s hepatic congestion, not left-sided failure’s pulmonary focus, making it unrelated here.

Choice E reason: Confusion may occur late in severe heart failure from hypoxia, but it’s not specific to left-sided failure’s early pulmonary symptoms like tachypnea.