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 answer is choice A: Administer pancreatic enzymes between meals if at all possible.

Choice A rationale:

Administer pancreatic enzymes between meals if at all possible. This is the correct choice. When educating the parents and child with cystic fibrosis about the administration of pancreatic enzymes, it's important to emphasize that these enzymes should be given between meals whenever feasible. Administering them between meals, when the stomach is less acidic and less likely to release the enzymes prematurely, ensures optimal digestion of food and absorption of nutrients. This approach aligns with the physiological need to supplement pancreatic enzyme function due to the inadequate natural enzyme production in cystic fibrosis.

Choice B rationale:

Pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal. This choice is a valid option for administering pancreatic enzymes. While it's true that the enzymes can be taken either by swallowing the capsules whole or by opening them and sprinkling the contents on a small amount of food at the start of a meal, this method can vary based on individual preferences and abilities. However, the primary focus should be on timing (between meals) to achieve the best enzymatic action.

Choice C rationale:

Do not administer pancreatic enzymes if the child is receiving antibiotics. This statement is not accurate. There is no general contraindication to administering pancreatic enzymes while a child is on antibiotics. However, it's important for the healthcare provider to be aware of all the medications the child is taking to ensure there are no potential drug interactions or effects on absorption. Always consult with the healthcare team before adjusting the administration of any medication.

Choice D rationale:

Decrease the dose of pancreatic enzymes if the child is having frequent, bulky stools. This statement is not consistent with typical practice. If a child is experiencing frequent, bulky stools, it may actually indicate that the pancreatic enzyme dosage needs adjustment (increasing the dose rather than decreasing). Bulky stools can suggest poor digestion and absorption, which might require more enzymes to properly break down nutrients. Dosage adjustments should always be made under the guidance of the healthcare provider based on factors such as stool consistency, weight gain, and nutritional status.

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.