lOMoARcPSD| 63525276
NUR 201:INTERMEDIATE MED-SURG (N201) –
NURSING MANAGEMENT OF HYPERTHYROIDISM
CASE STUDY | 2026 UPDATE VERIFIED Q&A
Scenario
K.B. is a 65-year-old man admitted to the hospital after a 5-day episode of “the flu” with complaints of
dyspnea on exertion, palpitations, chest pain, insomnia, and fatigue. K.B. was diagnosed with Graves’
disease 6 months ago and placed on methimazole (Tapazole) 15mg/day. His other past medical history
includes heart failure and hypertension requiring antihypertensive medications; however, he states that
he has not been taking these medications on a regular basis.
Vital signs (VS) are: 150/90, 124 irregular, 20, 100.2 ° F (37.9° C). Admission assessment findings are:
height 5ft, 8 in; weight 132lb; appears anxious and restless; loud heart sounds; 1+ pitting edema noted
in bilateral lower extremities; diminished breath sounds with fine crackles in the posterior bases. K.B.
begins to cry when he tells you he recently lost his wife; you notice someone has punched several more
holes in his belt so he could tighten it.
Chart View Laboratory Test Results
Hemoglobin (Hgb) 11.8g/dL
Hematocrit (Hct) 36%
Erythrocyte sedimentation rate (ESR) 48mm/hr
Sodium 141mmol/L
Potassium 4.7mmol/L
Chloride 101mmol/L
Blood urea nitrogen (BUN) 33mg/dL
Creatinine 1.9mg/dL
Free thyroxine (T4 ) 14.0ng/dL
Triiodothyronine (T3 ) 230ng/dL
1. Which of K.B.'s assessment findings represent manifestations of hypermetabolism?
Anxiety, tachycardia, fatigue, sudden weight loss, nervousness, irregular heart rate
2. Interpret K.B.'s laboratory results.
, lOMoARcPSD| 63525276
ESR, BUN, creatinine, T4 and T3 are all elevated. Increased BUN indicates that the pt has dehydration.
Increased ESR is related to infection, inflammation, and tissue necrosis or infarction. Decreased
hemoglobin and hematocrit could be due to hypermetabolic state. Increased T3 and T4 indicates
hyperthyroidism.
3. You go to assess K.B. What additional data do you need to obtain because he has Graves’ disease?
Assess for tremors, weight loss, eyes, sweating, muscle weakness, depression, double vision, and his
current medications.
Chart View Physician's Orders
Propranolol (Inderal) 20mg PO q6h Dexamethasone (Decadron) 10mg IV q6h Verapamil (Calan SR)
120mg/day PO Furosemide (Lasix) 80mg IV push now, then 40mg/day IVP Diet as tolerated STAT ECG
and echocardiogram Up ad lib IV of D5W at 125mL/hr Daily weights with intake and output (I&O)
4. The physician writes these admission orders. Which will you question, and why?
I would question the D5W order because this could lead to fluid volume overload and worsening cardiac
status since there is a possibility that he might have heart failure. I would also question Inderal and
Calan order because they should not be prescribed for patients with hx of HF.
5. Describe four priority problems related to K.B.'s nursing care.
- decreased CO from dysrhythmias and HF
- hyperthermia from increased heat production
- inadequate oxygenation from hypermetabolism
- inability to tolerate activity d/t increased metabolism
Case Study Progress
Later on your shift, you note that K.B. is extremely restless and disoriented to person, place, and time.
VS are 174/82, 180 and irregular, 32 and labored, 104° F (40° C). His electrocardiogram (ECG) shows
atrial fibrillation.
6. What is likely happening with K.B.? State your rationale
Elevated BP, tachycardia, temp, RR, and the onset of atrial fibrillation are signs of thyroid storm.
7. What will you do first?
I would call the rapid response team and place oxygen.
NUR 201:INTERMEDIATE MED-SURG (N201) –
NURSING MANAGEMENT OF HYPERTHYROIDISM
CASE STUDY | 2026 UPDATE VERIFIED Q&A
Scenario
K.B. is a 65-year-old man admitted to the hospital after a 5-day episode of “the flu” with complaints of
dyspnea on exertion, palpitations, chest pain, insomnia, and fatigue. K.B. was diagnosed with Graves’
disease 6 months ago and placed on methimazole (Tapazole) 15mg/day. His other past medical history
includes heart failure and hypertension requiring antihypertensive medications; however, he states that
he has not been taking these medications on a regular basis.
Vital signs (VS) are: 150/90, 124 irregular, 20, 100.2 ° F (37.9° C). Admission assessment findings are:
height 5ft, 8 in; weight 132lb; appears anxious and restless; loud heart sounds; 1+ pitting edema noted
in bilateral lower extremities; diminished breath sounds with fine crackles in the posterior bases. K.B.
begins to cry when he tells you he recently lost his wife; you notice someone has punched several more
holes in his belt so he could tighten it.
Chart View Laboratory Test Results
Hemoglobin (Hgb) 11.8g/dL
Hematocrit (Hct) 36%
Erythrocyte sedimentation rate (ESR) 48mm/hr
Sodium 141mmol/L
Potassium 4.7mmol/L
Chloride 101mmol/L
Blood urea nitrogen (BUN) 33mg/dL
Creatinine 1.9mg/dL
Free thyroxine (T4 ) 14.0ng/dL
Triiodothyronine (T3 ) 230ng/dL
1. Which of K.B.'s assessment findings represent manifestations of hypermetabolism?
Anxiety, tachycardia, fatigue, sudden weight loss, nervousness, irregular heart rate
2. Interpret K.B.'s laboratory results.
, lOMoARcPSD| 63525276
ESR, BUN, creatinine, T4 and T3 are all elevated. Increased BUN indicates that the pt has dehydration.
Increased ESR is related to infection, inflammation, and tissue necrosis or infarction. Decreased
hemoglobin and hematocrit could be due to hypermetabolic state. Increased T3 and T4 indicates
hyperthyroidism.
3. You go to assess K.B. What additional data do you need to obtain because he has Graves’ disease?
Assess for tremors, weight loss, eyes, sweating, muscle weakness, depression, double vision, and his
current medications.
Chart View Physician's Orders
Propranolol (Inderal) 20mg PO q6h Dexamethasone (Decadron) 10mg IV q6h Verapamil (Calan SR)
120mg/day PO Furosemide (Lasix) 80mg IV push now, then 40mg/day IVP Diet as tolerated STAT ECG
and echocardiogram Up ad lib IV of D5W at 125mL/hr Daily weights with intake and output (I&O)
4. The physician writes these admission orders. Which will you question, and why?
I would question the D5W order because this could lead to fluid volume overload and worsening cardiac
status since there is a possibility that he might have heart failure. I would also question Inderal and
Calan order because they should not be prescribed for patients with hx of HF.
5. Describe four priority problems related to K.B.'s nursing care.
- decreased CO from dysrhythmias and HF
- hyperthermia from increased heat production
- inadequate oxygenation from hypermetabolism
- inability to tolerate activity d/t increased metabolism
Case Study Progress
Later on your shift, you note that K.B. is extremely restless and disoriented to person, place, and time.
VS are 174/82, 180 and irregular, 32 and labored, 104° F (40° C). His electrocardiogram (ECG) shows
atrial fibrillation.
6. What is likely happening with K.B.? State your rationale
Elevated BP, tachycardia, temp, RR, and the onset of atrial fibrillation are signs of thyroid storm.
7. What will you do first?
I would call the rapid response team and place oxygen.
