The nurse is reviewing the past medical history of a group of clients. Which client would the nurse suspect as having folic acid deficiency? The:

hoice A reason: Preparing for endotracheal intubation and ventilatory support is not the action that the nurse should take for a client with thyroid storm. This intervention is indicated for clients with respiratory failure or impending airway obstruction, which are not the case for this client.

Choice B reason: Providing continuous sedation for pain relief is not the action that the nurse should take for a client with thyroid storm. This intervention may worsen the client's condition by suppressing the respiratory drive and lowering the blood pressure. The nurse should administer antithyroid medications, beta blockers, and corticosteroids as prescribed to reduce the thyroid hormone levels and the associated symptoms.

Choice C reason: Initiating cardiac monitoring and assessing for reflex bradycardia is not the action that the nurse should take for a client with thyroid storm. This intervention is indicated for clients with hyperkalemia or digoxin toxicity, which are not the case for this client. The nurse should monitor the client's heart rate and rhythm, but not expect a reflex bradycardia, which is a paradoxical slowing of the heart rate in response to a rapid rise in blood pressure.

Choice D reason: Maintaining IV fluid infusion and assessing adequacy of hydration is the action that the nurse should take for a client with thyroid storm. This intervention is indicated for clients with thyroid storm, as they are at risk of dehydration and electrolyte imbalance due to increased metabolic rate, fever, sweating, vomiting, and diarrhea. The nurse should administer isotonic fluids, such as normal saline, and monitor the client's fluid intake and output, urine specific gravity, and serum electrolytes.

Choice A reason: Chlorthalidone and atenolol are used to treat hypertension⁴⁵. However, administering the medication when the blood pressure is 90/60 might not be advisable. This is because atenolol, a beta-blocker, can further lower the heart rate and blood pressure¹¹⁷. Therefore, it's important to monitor the patient's blood pressure before administration¹.

Choice B reason: Atenolol can slow the heart rate¹¹⁷. If the heart rate is already less than 60 beats per minute, which is the lower limit of the normal range¹, the medication should be held and the healthcare provider should be notified⁵.

Choice C reason: One of the side effects of atenolol and chlorthalidone is dizziness or lightheadedness¹¹⁷. Teaching the patient to dangle their feet before standing can help prevent orthostatic hypotension, a form of low blood pressure that happens when you stand up from sitting or lying down¹¹.

Choice D reason: Chlorthalidone is a diuretic that can cause the body to lose potassium¹¹⁷. However, atenolol does not have this effect⁵. Therefore, it's not necessary to limit the intake of potassium-rich foods unless advised by a healthcare provider.

Choice E reason: Monitoring fluid intake and output is important when administering diuretics like chlorthalidone⁵. This can help ensure the patient is not becoming dehydrated and help monitor the medication's effectiveness¹¹.