Which of the following clinical manifestations following a thyroidectomy would alert the nurse that a client is going into a life-threatening thyroid storm? Select 3

Thyroid storm is a rare but life-threatening hypermetabolic emergency that can be triggered by physiologic stress such as surgery, including thyroidectomy. Its cardinal clinical manifestations include severe tachycardia (heart rate above 140–180 bpm is common), extreme agitation or altered mental status, and high fever (often above 101–104°F). A heart rate of 184 on telemetry reflects the profound sympathetic overstimulation and excess thyroid hormone effect on the heart. Extreme agitation reflects central nervous system hyperactivity. A temperature of 102.4°F is consistent with the hyperpyrexia seen in thyroid storm, which can escalate rapidly. These three findings together strongly suggest thyroid storm and require immediate intervention including antithyroid medications, beta-blockers, corticosteroids, and supportive cooling. The inability to close the eyelids (lagophthalmos or exophthalmos) is associated with Graves' disease-related ophthalmopathy, which is a chronic finding rather than an acute sign of thyroid storm. Bruising on the knees and feet suggests a coagulation or trauma issue unrelated to the hyperthyroid crisis. Recognizing these three defining features — tachycardia, fever, and neurological agitation — is critical for rapid identification and treatment of this emergency.