A nurse is teaching a client who has Graves' disease about recognizing the manifestations of thyroid storm. Which of the following findings should the nurse include in the teaching?

Choice A reason: Taking two tablets PO every 15 minutes is not the standard protocol for nitroglycerin administration for chest pain. This method could lead to an overdose and significant hypotension (low blood pressure), which can be dangerous.

Choice B reason: One tablet SL every 15 minutes, up to 5 times, is also not the standard protocol. While sublingual administration is correct, the frequency and the total number of doses are higher than recommended, which could result in adverse effects such as headache, dizziness, or a severe drop in blood pressure.

Choice C reason: One tablet PO every one hour, up to 5 times, is not a recommended method for acute chest pain relief from angina. Oral administration does not provide the rapid onset of action required for acute angina relief.

Choice D reason: One tablet SL every 5 minutes, up to 3 times, is the correct protocol for nitroglycerin administration when experiencing chest pain due to angina. If pain persists after the first dose, the patient can take a second dose after 5 minutes, and if needed, a third dose after another 5 minutes. If chest pain continues after three doses in 15 minutes, emergency medical help should be sought immediately.

Choice A reason: The fluctuation of fluid in the water-seal chamber does not necessarily mean that the lung is fully re-expanded. The water-seal chamber's fluid level fluctuates with the client's breathing because it reflects the changes in intrathoracic pressure.

Choice B reason: The statement "Your breathing pattern causes this" is correct. The fluctuation, also known as tidaling, in the water-seal chamber is normal and occurs in response to the client's breathing. When the client inhales, negative pressure in the chest cavity causes the fluid level to rise, and when the client exhales, the pressure becomes positive, causing the fluid level to fall.

Choice C reason: Suction pressure that is too high can cause continuous bubbling in the suction control chamber but does not directly cause the fluid in the water-seal chamber to rise and fall. The suction control chamber's bubbling should be steady and gentle when the suction is set correctly.

Choice D reason: Continuous bubbling in the water-seal chamber may indicate an air leak, which is a problem that needs to be addressed. However, normal fluctuation with breathing is not indicative of an air leak.