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: Calcium carbonate supplements increase serum calcium by providing exogenous calcium, worsening hyperparathyroidism’s already elevated levels from excessive PTH-driven bone resorption and gut absorption.

Choice B reason: A low calcium diet reduces intake, limiting absorption, while high fiber binds calcium in the gut, enhancing fecal excretion, countering PTH’s hypercalcemic effect in hyperparathyroidism.

Choice C reason: Parathyroidectomy removes overactive glands, directly stopping excessive PTH production, which drives calcium release from bones and reabsorption in kidneys, effectively normalizing calcium levels.

Choice D reason: Furosemide, a loop diuretic, increases renal calcium excretion by inhibiting reabsorption in the loop of Henle, reducing serum calcium elevated by PTH in hyperparathyroidism.

Choice E reason: Fluid restriction raises calcium concentration by reducing dilution, worsening hypercalcemia in hyperparathyroidism, where PTH already increases calcium reabsorption, making this counterproductive.

Choice A reason: Fever of 103°F may occur in thyroid storm, not goiter, which is simply thyroid enlargement without systemic hypermetabolism or infection necessarily.

Choice B reason: Goiter is defined by thyroid gland enlargement, often from iodine deficiency or hyperplasia, palpable as a neck mass, the core characteristic here.

Choice C reason: Fibrotic tissue in arterioles relates to vascular diseases, not goiter, which involves thyroid tissue growth, not arterial structural changes.

Choice D reason: Glycosaminoglycan deposits occur in myxedema (hypothyroidism), not goiter, which is enlargement alone, not skin or connective tissue alteration.