NR511 Week 6 Quiz Latest 2020 MAY

NR511 Differential Diagnosis and Primary Care

Week 6 Quiz

Question 1 The most common cause of hyperthyroidism is: 

Graves disease.

A pituitary tumor.

Subacute thyroiditis.

A toxic uninodulargoiter.

Question 2 An elderly client presents with atrial fibrillation. Which of the following lab tests is important in forming the diagnosis? 

Comprehensive metabolic panel (CMP).

Thyroid-stimulating hormone (TSH).

C-reactive protein (CRP).

Complete blood count (CBC).

Question 3 A client presents with clinical manifestations of hyperthyroidism. The differential diagnosis includes Graves disease and subacute thyroiditis. Which of the following findings is consistent with subacute thyroiditis? 

A 24-hour radioactive iodine uptake (RAIU) demonstrating increased uptake.

A 24-hour radioactive iodine uptake (RAIU) demonstrating a “cold” nodule.

A 24-hour radioactive iodine uptake (RAIU) demonstrating decreased uptake.

A fine-needle aspiration is required for diagnosis of subacute thyroiditis.

Question 4 A 24-year-old female is preparing for radioactive iodine therapy to treat Graves disease. Which test must she undergo first?

Basal metabolism rate.

Lithium level.

Serum calcium.

Beta-human chorionic gonadotropin.

Question 5 Which of the following statements about hypothyroidism is not true? 

The most common worldwide cause of hypothyroidism is iodine deficiency.

Lithium use is a risk factor for hypothyroidism.

The rate of hypothyroidism decreases with age.

The most common cause of autoimmune hypothyroidism is Hashimoto thyroiditis.

Question 6 Which of the following objective findings in a 49-year-old female is a sign of hyperthyroidism? 

Decreased systolic blood pressure (BP).

Dry, coarse, cool skin.

Exophthalmos.

Slow pulse.

Question 7 What is the medication of choice for an initial acute attack of gout?

Allopurinol (Zyloprim).

Colchicine.

A nonsteroidal anti-inflammatory drug (NSAID).

A corticosteroid.

Question 8 A 46-year-old male presents with a tender, red and swollen knee. The clinician orders a complete blood count (CBC) with differential, uric acid level and erythrocyte sedimentation rate (ESR). Which of the following results would make the clinician suspect a septic joint rather than gout?

High uric acid level and a decreased Erythrocyte Sedimentation Rate (ESR).

Elevated white blood cell (WBC) count and an elevated Erythrocyte Sedimentation Rate (ESR).

Normal Erythrocyte Sedimentation Rate (ESR) and a decreased uric acid level.

Decreased white blood cell (WBC) count and an elevated uric acid level.

Question 9 A 6-year-old girl was bitten by a friend’s dog. Her mother asks the clinician if the child needs anti-rabies treatment. Which of the following should the clinician advise?

 “Anti-rabies treatment must be started immediately.”

 “Wait until you have observed the animal for 2 weeks to determine if it is rabid.”

 “If the dog is a domestic pet that has been vaccinated, wound cleansing and irrigation is the only treatment needed.”

 “Rabies can be contracted only through the bites of wild animals.”

Question 10 Alice, age 48, has a benign thyroid nodule. The most common treatment involves:

Watchful waiting with annual follow-up.

Radioactive iodine therapy.

Administration of levothyroxine therapy.

Surgery.

Question 11 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?

Start propranolol every 8 hours.

Increase the levothyroxine dosage.

Keep the dosage the same.

Decrease the levothyroxine dosage.

Question 12 A 72-year-old obese male has gout. When teaching him about diet, which of the following should the clinician advise? 

 “You must go on a restricted, very low calorie diet to effect immediate change.”

 “Keeping your weight stable, even if you are a little overweight, is better than fluctuating.”

"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.”

Question 13 Which of the following body mass index (BMI) values defines class 1 obesity?

30

35

40

25

Question 14 A low thyroid-stimulating hormone (TSH) can lead to: 

Osteoporosis.

Bradycardia.

Brittle hair.

Weight gain.

Question 15 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).

Order a thyroid ultrasound.

Prescribe a beta-adrenergic blocker.

Refer the client for immediate evaluation by an ophthalmologist.