A nurse is assessing a client who is 12 hours postoperative following a thyroidectomy. Which of the following findings is indicative of thyrotoxic crisis?

A. Atrial fibrillation is characterized by irregularly irregular rhythms with no distinct P-waves. Instead, it has a chaotic baseline with fibrillatory waves. The ventricular response can be irregular and variable. The description provided (regular P-waves in a sawtooth formation) does not match the typical appearance of atrial fibrillation, which lacks regular P-waves and has an irregular rhythm.
B. Atrial flutter is characterized by regular, sawtooth-shaped P-waves known as "F-waves" or "flutter waves." The classic pattern is referred to as "F-waves" with a "sawtooth" appearance, often seen in the inferior leads (II, III, aVF). The atrial rate is typically between 240 to 340 beats per minute, which fits the rate of 260 beats per minute in the description. The ventricular rate can be regular or irregular, depending on the degree of AV node conduction. A

C. Unstable angina is a clinical diagnosis of chest pain due to myocardial ischemia. It is not associated with specific ECG findings related to the P-wave morphology or rate. The ECG findings described do not correspond to unstable angina, which would typically present with ST-segment changes or other signs of myocardial ischemia rather than a specific P-wave pattern.
D. Premature atrial contractions (PACs) are early beats originating from the atria that interrupt the normal rhythm. They usually present as a single early beat with a different morphology of the P-wave compared to the sinus P-waves, but do not result in a regular sawtooth pattern or a sustained rhythm at high rates like the one described.

1. Begin Broad Spectrum IV Antibiotics Anticipated
The client's symptoms, including right upper quadrant pain, nausea, vomiting, jaundice, fever, and elevated white blood cell count, suggest a potential infection or inflammation in the abdominal area, possibly related to the biliary system (e.g., cholecystitis or cholangitis). Broad-spectrum antibiotics are commonly used to treat infections that could be causing these symptoms, especially if the exact pathogen is not yet identified. The elevated white blood cell count further supports the likelihood of an infection.
2. Transfuse 1 Unit of Packed Red Blood Cells Contraindicated
There is no indication from the provided information that the client has anemia or a significant drop in hemoglobin that would necessitate a blood transfusion. The hemoglobin level is 15.1 g/dL, which is within normal limits. Blood transfusion would typically be considered if there was evidence of significant blood loss or anemia, neither of which is indicated by the client’s current lab results.
3. Prepare Client for Endoscopic Retrograde Cholangiopancreatography (ERCP) Anticipated
The symptoms described, including right upper quadrant pain radiating to the right shoulder, jaundice, and the dark amber urine, are suggestive of biliary tract involvement, such as gallstones causing obstruction or infection. ERCP is a diagnostic and therapeutic procedure used to visualize and treat conditions of the bile ducts and pancreatic ducts. Given the symptoms and clinical presentation, preparing the client for an ERCP to assess and potentially address issues in the biliary system is appropriate.

4. Administer Morphine Sulfate IV Push for Pain Contraindicated
The client has a documented allergy to morphine. Administering morphine could lead to an allergic reaction and is therefore contraindicated. Alternative pain management options should be considered, such as non-opioid analgesics or other opioid medications that the client is not allergic to.