NR 511 week 6 quiz

Question 1

1 / 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).

Correct!

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

1 / 1 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 thyroidstimulating 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?

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