The nurse is caring for a school-age child with hyperthyroidism (Graves' disease). Which clinical manifestations should the nurse monitor that may indicate a thyroid storm? (Select all that apply.)

The correct answers are Choice A: Diabetes mellitus, Choice E: Urinary tract infection (UTI).

Choice A rationale:

Diabetes mellitus. This is one of the correct choices. Diabetes can lead to increased urinary frequency, urgency, and secondary enuresis (bedwetting) due to the impact of elevated blood glucose levels on the kidneys and bladder function.

Choice B rationale:

Hypocalciuria is not directly relevant to evaluating secondary enuresis with dysuria or urgency. Hypocalciuria refers to a lower-than-normal level of calcium in the urine and is not a common cause of urinary symptoms in this context.

Choice C rationale:

Nephrotic syndrome primarily involves the kidneys and is characterized by proteinuria, edema, hypoalbuminemia, and hyperlipidemia. While it can cause changes in urinary patterns, it is not typically associated with dysuria or urgency.

Choice D rationale:

Glomerulonephritis refers to inflammation of the glomeruli, which are the tiny filters in the kidneys. It can lead to hematuria (blood in the urine) and proteinuria, but it is not commonly associated with dysuria or urgency.

Choice E rationale:

Urinary tract infection (UTI). This is one of the correct choices. UTIs can cause symptoms such as dysuria (painful urination), urgency, and frequency. These symptoms are especially relevant in the context of evaluating a child with secondary enuresis.

The correct answer is choice B. Reduce gastric acid production.

Choice A rationale:

Preventing reflux is not the primary purpose of prescribing a histamine receptor antagonist. Histamine receptor antagonists work by reducing gastric acid production, which in turn can help alleviate symptoms of gastroesophageal reflux disease (GERD). They do not directly prevent the physical reflux of stomach contents into the esophagus.

Choice B rationale:

The primary purpose of prescribing a histamine receptor antagonist for an infant diagnosed with gastroesophageal reflux is to reduce gastric acid production. Histamine stimulates acid secretion in the stomach, and these medications (e.g., ranitidine, famotidine) block histamine receptors on stomach cells, leading to decreased acid secretion. This helps reduce the acidity of stomach contents that could contribute to esophageal irritation in GERD.

Choice C rationale:

Preventing hematemesis (vomiting blood) is not a primary action of histamine receptor antagonists. While reducing gastric acid production might indirectly help prevent complications such as bleeding due to irritation and inflammation of the esophagus, it's not the main purpose of these medications.

Choice D rationale:

Increasing gastric acid production is the opposite of the intended effect of histamine receptor antagonists. These medications are specifically used to decrease gastric acid production and provide relief from conditions where excess acid is causing problems, such as GERD.