A nurse is reviewing the medical record of a client who has hyperthyroidism (Graves disease). Which of the following serum laboratory findings should the nurse expect to be below the expected reference range?

Choice A: Maintain the client in Fowler’s position. This is correct because Fowler’s position, which is a semi-sitting position with the head of the bed elevated 45 to 60 degrees, can facilitate the drainage of gastric contents and reduce the risk of aspiration.

Choice B: Use sterile water to irrigate the nasogastric tube. This is incorrect because sterile water is not necessary to irrigate the nasogastric tube, unless the client is immunocompromised or has a high risk of infection. Tap water or normal saline can be used to irrigate the nasogastric tube, following the provider’s orders or the facility’s protocol.

Choice C: Moisten the client’s lips with lemon-glycerin swabs. This is incorrect because lemon-glycerin swabs can dry out and irritate the client’s lips and oral mucosa, especially if used frequently. The nurse should use water-soluble lubricant or lip balm to moisturize the client’s lips and mouth.

Choice D: Measure abdominal girth daily. This is incorrect because measuring abdominal girth daily is not enough to monitor the progression of the intestinal obstruction and the effectiveness of the gastrointestinal decompression. The nurse should measure abdominal girth more frequently, such as every 4 hr or every shift, and report any changes or abnormalities.

Choice A: Sensitivity to cold. This is incorrect because sensitivity to cold is a manifestation of hypothyroidism, not hyperthyroidism. Clients with hyperthyroidism have increased metabolism and heat production, which makes them more sensitive to heat.

Choice B: Frequent mood changes. This is correct because frequent mood changes are a manifestation of hyperthyroidism. Clients with hyperthyroidism have increased levels of thyroid hormones, which can affect their nervous system and cause irritability, anxiety, nervousness, or emotional instability.

Choice C: Weight gain. This is incorrect because weight gain is a manifestation of hypothyroidism, not hyperthyroidism. Clients with hyperthyroidism have increased metabolism and appetite, which makes them lose weight or have difficulty gaining weight.

Choice D: Constipation. This is incorrect because constipation is a manifestation of hypothyroidism, not hyperthyroidism. Clients with hyperthyroidism have increased bowel motility and peristalsis, which makes them more prone to diarrhea or frequent stools.