While assessing a client with Graves disease, the nurse notes that the client's temperature has risen 1 degree Fahrenheit. Which action should the nurse take first?

Choice A rationale: Hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is characterized by extremely high blood glucose levels (often over 600 mg/dL), severe dehydration, and altered mental status. The presence of negative ketones differentiates it from diabetic ketoacidosis. The body's remaining insulin production is enough to prevent ketosis but not enough to control severe hyperglycemia.
Choice B rationale: Diabetic ketoacidosis (DKA) is a severe complication characterized by hyperglycemia, dehydration, and the presence of ketones in the blood and urine. The client's lab results in this scenario specifically state "negative ketones," which rules out DKA as the primary diagnosis. Fruity breath would also be present in DKA.
Choice C rationale: Diabetic neuropathy is a long-term complication of diabetes that affects the nerves, leading to symptoms like numbness, tingling, or pain. It is a chronic condition and does not manifest with the acute metabolic crisis of extremely high blood glucose (1000 mg/dL), dehydration, and malaise described in the scenario.
Choice D rationale: Diabetic nephropathy is a chronic complication affecting the kidneys, characterized by progressive kidney damage and eventual kidney failure. While elevated BUN can be a sign, the acute presentation with extremely high glucose and dehydration is more indicative of a life-threatening metabolic emergency like HHNS rather than chronic organ damage.

Choice A rationale: An elevated temperature in a patient with Grave's disease, a form of hyperthyroidism, can be an early sign of a life-threatening condition called thyroid storm or thyrotoxic crisis. This is a severe, acute exacerbation of hyperthyroidism characterized by extreme hypermetabolism. The body's inability to cope with this heightened metabolic state leads to fever, tachycardia, severe hypertension, and potential heart failure, requiring immediate medical intervention to stabilize the patient. Normal body temperature is around 36.5-37.5°C (97.7-99.5°F).
Choice B rationale: Elevated blood pressure is a common finding in hyperthyroidism due to increased cardiac output and peripheral vasodilation. While it is a significant finding that requires monitoring and management, it does not typically pose the immediate, life-threatening risk that a sudden and marked elevation in body temperature suggests, which is a hallmark of an impending thyroid storm. Normal blood pressure is <120/80 mmHg.
Choice C rationale: A change in respiratory rate, such as an increase, can be associated with the hypermetabolic state of hyperthyroidism. However, it is a less specific and often less immediate indicator of a thyrotoxic crisis than a fever. While respiratory distress can occur, especially in severe cases, the elevated temperature is a more direct and urgent sign of systemic decompensation. Normal respiratory rate is 12-20 breaths per minute.
Choice D rationale: Irregular heart rate and rhythm, particularly atrial fibrillation, are frequent complications of hyperthyroidism. The excess thyroid hormone sensitizes the heart to catecholamines, leading to arrhythmias. While this requires careful management to prevent complications like stroke, it is a chronic manifestation. A new or sudden onset of fever is a more acute and urgent indicator of a potentially fatal crisis. Normal heart rate is 60-100 bpm.