nr 511 differential diagnosis and primary care practicum
chamberlain
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NR 511
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Score for this quiz: 15 out of 15
Question 1
pts
What is the medication of choice for an initial acute attack of gout?
A corticosteroid.
Colchicine.
Allopurinol (Zyloprim).
Correct!
A nonsteroidal anti-inflammatory drug (NSAID).
The medication of choice for an initial acute attack of gout is an NSAID. Indomethacin
(Indocin) is the most commonly prescribed NSAID for this use. An initial dose of 50 to
75 mg is given, followed by 25 to 50 mg every 8 hours for 5 to 10 days. An alternative to
indomethacin is naproxen (Naprosyn). The first dose of naproxen is 750 mg, followed by
250 mg every 8 hours for 5 to 10 days.
Question 2
pts
Which of the following statements about hypothyroidism is not true?
Lithium use is a risk factor for hypothyroidism.
The most common cause of autoimmune hypothyroidism is Hashimoto thyroiditis.
The most common worldwide cause of hypothyroidism is iodine deficiency.
Correct!
, The rate of hypothyroidism decreases with age.
This is not true; hypothyroidism becomes more common as we age.
Question 3
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 thyroid ultrasound.
Prescribe a beta-adrenergic blocker.
Order a total thyroxine (T4).
Correct!
Refer the client for immediate evaluation by an ophthalmologist.
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 4
pts
A low thyroid-stimulating hormone (TSH) can lead to:
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