Order a total thyroxine (T4).
Refer the client for immediate evaluation by an ophthalmologist.
Order a thyroid ultrasound.
Prescribe a beta-adrenergic blocker.
The practitioner should refer the client for an immediate evaluation by an ophthalmologist. Clinically recognized Grave...
NR 511 wk 6 quiz
Question 1
pts
A client with hyperthyroidism presents with a complaint of a “gritty” feeling in her eyes. Over
the past week, her visual acuity has diminished, and her ability to see colors has changed. She
also has a feeling of pressure behind her eyes. The next step for the nurse practitioner is to:
Order a total thyroxine (T4).
Refer the client for immediate evaluation by an ophthalmologist.
Order a thyroid ultrasound.
Prescribe a beta-adrenergic blocker.
The practitioner should refer the client for an immediate evaluation by an ophthalmologist.
Clinically recognized Graves ophthalmopathy occurs in about 50% of cases of Graves disease.
A client with Graves orbitopathy with these complaints is at risk of blindness if there is
compression of the optic nerve. Additional symptoms include photophobia and diplopia.
Autoantibodies present in Graves disease can cause increased muscle thickness in the eye,
leading to edema and compression of the optic nerve. Fundal exam may reveal disk swelling.
This is an emergency situation that may require hospitalization and treatment with prednisone to
diminish the inflammation. Artificial tears are also helpful. In 75% of clients, the onset of
Graves orbitopathy occurs within a year before or after the diagnosis of thyrotoxicosis but can
sometimes precede or follow thyrotoxicosis by several years.
Question 2
pts
A 23-year-old female complains of palpitations that started a few weeks ago; they occur 2 to 4
times a day and last 5 to 10 minutes. She feels nervous and is having trouble sleeping. Her stools
have been frequent (1-3 per day) and loose. She is taking levothyroxine 150 µg daily. Her labs
indicate free thyroxine (FT4) 2.28 and thyroid-stimulating hormone (TSH) 0.022. She has a
history of Graves disease and had radioactive iodine (RAI) treatment a few months ago. She has
been on thyroid replacement for 2 months. Based on these findings, what should the clinician do
next?
, Decrease the levothyroxine dosage.
Increase the levothyroxine dosage.
Start propranolol every 8 hours.
Keep the dosage the same.
It appears that she may be overcorrected. The usual dosage of thyroid replacement is 1.6
µg/kg/d. She could skip a dose and then resume at a lower dosage of 125 to 137 µg per day. In
an older individual, the lower dose would be preferred because overcorrection can lead to atrial
fibrillation. She should take the levothyroxine on an empty stomach with a full glass of water
and wait 30 minutes before eating for maximum absorption.
Question 3
pts
A 72-year-old obese male has gout. When teaching him about diet, which of the following should
the clinician advise?
"A diet high in red meat will prevent formation of kidney stones."
“Fluid intake should exceed three thousand milliliters daily to prevent formation of uric acid
kidney stones.”
“Keeping your weight stable, even if you are a little overweight, is better than fluctuating.”
“You must go on a restricted, very low calorie diet to effect immediate change.”
Fluid intake should exceed 3000 mL daily to prevent formation of uric acid kidney stones.
Clients should avoid dehydration because it may precipitate an acute attack.
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