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MSN Exam for Hyperthyroidism (PM)
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Question 1
Which nursing diagnosis takes highest priority for a female client with hyperthyroidism?
A
Body image disturbance related to weight gain and edema
B
Imbalanced nutrition: Less than body requirements related to thyroid hormone excess
C
Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing
D
Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess
Question 1 Explanation:
In the client with hyperthyroidism, excessive thyroid hormone production leads to hypermetabolism and increased nutrient metabolism. These conditions may result in a negative nitrogen balance, increased protein synthesis and breakdown, decreased glucose tolerance, and fat mobilization and depletion. This puts the client at risk for marked nutrient and calorie deficiency, making Imbalanced nutrition: Less than body requirements the most important nursing diagnosis.
Question 2
For the patient with hyperthyroidism, what intervention should you delegate to the experienced certified nursing assistant?
A
Explain the side effects of propylthiouracil (PTU) to the patient.
B
Check the apical pulse, blood pressure, and temperature every 4 hours.
C
Draw blood for thyroid-stimulating hormone, T3, and T4 levels.
D
Instruct the patient to report palpitations, dyspnea, vertigo, pr chest pain.
Question 2 Explanation:
Monitoring and recording vital signs are within the education scope of nursing assistants. An experienced nursing assistant should have been taught how to monitor the apical pulse. However, the nurse should observe the nursing assistant to be sure that she has mastered this skill. Instructing and teaching patients, as well as performing venipuncture for laboratory samples, are more suited to the educational scope of licensed nurses. In some facilities, an experienced nursing assistant may perform venipuncture, but only after special training. Focus: Delegation/supervision
Question 3
A client is being returned after subtotal thyroidectomy. Which piece of equipment is most important for the nurse to keep at the client’s bedside?
A
Cardiac monitor and oxygen tank
B
Tracheostomy set
C
Indwelling catheter tray
D
Orange juice and hard candy
Question 3 Explanation:
After subtotal thyroidectomy, swelling of the surgical site ( the tracheal area) may obstruct the airway. Therefore tracheostomy set should be at the bedside in case of respiratory emergency.
Question 4
Which change in vital signs would you instruct a nursing assistant to report immediately for a patient with hyperthyroidism?
A
Decreased oral temperature
B
Increased and rapid heart rate
C
Decrease systolic blood pressure
D
Increased respiratory rate
Question 4 Explanation:
The cardiac problems associated with hyperthyroidism include tachycardia, increased systolic blood pressure, and decreased diastolic blood pressure. Patients with hyperthyroidism also may have increased body temperature related to increased metabolic rate. Focus: Delegation/supervision
Question 5
A 38 year old woman returns from a subtotal thryroidectomy for the treatment of hyperthyroidism. Upon assessment, the immediate priority that the nurse would include is:
A
Assess for neurological status
B
Assess for respiratory distress
C
Assess fluid volume status
D
Assess for pain
Question 5 Explanation:
Though fluid volume status, neurological status and pain are all important assessment, the immediate priority for postoperative is the airway management. Respiratory distress may result from hemorrhage, edema, laryngeal damage or tetany.
Question 6
Which of the following nursing assessment is the most important in the patient with hyperthyroidism and risk for thyrotoxic crisis or thyroid storm?
A
Bowel sounds
B
Heart sounds
C
Vital signs
D
Intake and output
Question 7
Which medication will the nurse have available for emergency treatment of tetany in the client who has had thyroidectomy?
A
Magnesium chloride
B
Calcium chloride
C
Sodium bicarbonate
D
Potassium chloride
Question 8
Matilda, with hyperthyroidism is to receive Lugol’s iodine solution before a subtotal thyroidectomy is performed. The nurse is aware that this medication is given to:
A
Maintain the function of the parathyroid glands.
B
Decrease the size and vascularity of the thyroid gland.
C
Decrease the total basal metabolic rate.
D
Block the formation of thyroxine by the thyroid gland.
Question 8 Explanation:
Lugol’s solution provides iodine, which aids in decreasing the vascularity of the thyroid gland, which limits the risk of hemorrhage when surgery is performed.
Question 9
What are the functions of T3 and T4?
A
Regulation of energy production
B
Maintenance of blood sugar
C
Retention of salt and water
D
Maintenance of blood pressure
Question 10
Untreated hyperthyroidism during pregnancy may result in all of the following except:
A
Preeclampsia
B
Premature birth and miscarriage
C
Low birthweight
D
Autism
Question 10 Explanation:
In addition to the above-mentioned complications of uncontrolled hyperthyroidism in pregnancy, expectant mothers may suffer congestive heart failure and thyroid storm, which is life-threatening thyrotoxicosis with symptoms that include agitation, confusion, tachycardia, shaking, sweating, diarrhea, fever, and restlessness.
Question 11
A client with hyperthyroidism is taking lithium carbonate to inhibit thyroid hormone release. Which complaint by the client should alert the nurse to a problem with the client’s medication?
A
The client complains of increased weight gain over the past year.
B
The client complains of ringing in the ears.
C
The client complains of increased thirst and increased urination.
D
The client complains of blurred vision.
Question 11 Explanation:
Increased thirst and increased urination are signs of lithium toxicity.
Question 12
Which nursing diagnosis takes highest priority for a client with hyperthyroidism?
A
Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing
B
Imbalanced nutrition: Less than body requirements related to thyroid hormone excess
C
Body image disturbance related to weight gain and edema
D
Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess
Question 12 Explanation:
In the client with hyperthyroidism, excessive thyroid hormone production leads to hypermetabolism and increased nutrient metabolism. These conditions may result in a negative nitrogen balance, increased protein synthesis and breakdown, decreased glucose tolerance, and fat mobilization and depletion. This puts the client at risk for marked nutrient and calorie deficiency, making Imbalanced nutrition: Less than body requirements the most important nursing diagnosis.
Question 13
The physician orders laboratory tests to confirm hyperthyroidism in a female client with classic signs and symptoms of this disorder. Which test result would confirm the diagnosis?
A
No increase in the thyroid-stimulating hormone (TSH) level after 30 minutes during the TSH stimulation test
B
A decreased TSH level
C
An increase in the TSH level after 30 minutes during the TSH stimulation test
D
Below-normal levels of serum triiodothyronine (T3) and serum thyroxine (T4) as detected by radioimmunoassay
Question 13 Explanation:
In the TSH test, failure of the TSH level to rise after 30 minutes confirms hyperthyroidism. A decreased TSH level indicates a pituitary deficiency of this hormone. Below-normal levels of T3 and T4, as detected by radioimmunoassay, signal hypothyroidism. A below-normal T4 level also occurs in malnutrition and liver disease and may result from administration of phenytoin and certain other drugs.
Question 14
A patient is admitted to the medical unit with possible Graves’ disease (hyperthyroidism). Which assessment finding supports this diagnosis?
A
Bradycardia
B
Hoarse voice
C
Exophthalmos
D
Periorbital edema
Question 14 Explanation:
Exophthalmos (abnormal protrusion of the eye) is characteristic of patients with hyperthyroidism due to Graves’ disease. Periorbital edema, bradycardia, and hoarse voice are all characteristics of patients with hypothyroidism. Focus: Prioritization
Question 15
Ms.Clark has hyperthyroidism and is scheduled for a thyroidectomy. The physician has ordered Lugol’s solution for the client. The nurse understands that the primary reason for giving Lugol’s solution preoperatively is to:
A
prevent tetany while the client is under general anesthesia.
B
decrease the risk of agranulocytosis postoperatively.
C
potentiate the effect of the other preoperative medication so less medicine can be given while the client is under anesthesia.
D
reduce the size and vascularity of the thyroid and prevent hemorrhage.
Question 15 Explanation:
Doses of over 30 mg/day may increase the risk of agranulocytosis. Lugol’s solution does not act to prevent tetany. Calcium is used to treat tetany. The client may receive iodine solution (Lugol’s solution) for 10 to 14 days before surgery to decrease vascularity of the thyroid and thus prevent excess bleeding. Lugol’s solution does not potentiate any other preoperative medication.
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MSN Exam for Hyperthyroidism (EM)
Choose the letter of the correct answer. You got 15 minutes to finish the exam .Good luck!
Start
Congratulations - you have completed MSN Exam for Hyperthyroidism (EM).
You scored %%SCORE%% out of %%TOTAL%%.
Your performance has been rated as %%RATING%%
Your answers are highlighted below.
Question 1
Which of the following nursing assessment is the most important in the patient with hyperthyroidism and risk for thyrotoxic crisis or thyroid storm?
A
Vital signs
B
Bowel sounds
C
Heart sounds
D
Intake and output
Question 2
A patient is admitted to the medical unit with possible Graves’ disease (hyperthyroidism). Which assessment finding supports this diagnosis?
A
Exophthalmos
B
Bradycardia
C
Hoarse voice
D
Periorbital edema
Question 2 Explanation:
Exophthalmos (abnormal protrusion of the eye) is characteristic of patients with hyperthyroidism due to Graves’ disease. Periorbital edema, bradycardia, and hoarse voice are all characteristics of patients with hypothyroidism. Focus: Prioritization
Question 3
What are the functions of T3 and T4?
A
Retention of salt and water
B
Regulation of energy production
C
Maintenance of blood sugar
D
Maintenance of blood pressure
Question 4
Which change in vital signs would you instruct a nursing assistant to report immediately for a patient with hyperthyroidism?
A
Decrease systolic blood pressure
B
Decreased oral temperature
C
Increased and rapid heart rate
D
Increased respiratory rate
Question 4 Explanation:
The cardiac problems associated with hyperthyroidism include tachycardia, increased systolic blood pressure, and decreased diastolic blood pressure. Patients with hyperthyroidism also may have increased body temperature related to increased metabolic rate. Focus: Delegation/supervision
Question 5
A 38 year old woman returns from a subtotal thryroidectomy for the treatment of hyperthyroidism. Upon assessment, the immediate priority that the nurse would include is:
A
Assess fluid volume status
B
Assess for pain
C
Assess for respiratory distress
D
Assess for neurological status
Question 5 Explanation:
Though fluid volume status, neurological status and pain are all important assessment, the immediate priority for postoperative is the airway management. Respiratory distress may result from hemorrhage, edema, laryngeal damage or tetany.
Question 6
Which nursing diagnosis takes highest priority for a client with hyperthyroidism?
A
Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing
B
Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess
C
Imbalanced nutrition: Less than body requirements related to thyroid hormone excess
D
Body image disturbance related to weight gain and edema
Question 6 Explanation:
In the client with hyperthyroidism, excessive thyroid hormone production leads to hypermetabolism and increased nutrient metabolism. These conditions may result in a negative nitrogen balance, increased protein synthesis and breakdown, decreased glucose tolerance, and fat mobilization and depletion. This puts the client at risk for marked nutrient and calorie deficiency, making Imbalanced nutrition: Less than body requirements the most important nursing diagnosis.
Question 7
A client with hyperthyroidism is taking lithium carbonate to inhibit thyroid hormone release. Which complaint by the client should alert the nurse to a problem with the client’s medication?
A
The client complains of increased weight gain over the past year.
B
The client complains of ringing in the ears.
C
The client complains of increased thirst and increased urination.
D
The client complains of blurred vision.
Question 7 Explanation:
Increased thirst and increased urination are signs of lithium toxicity.
Question 8
Which nursing diagnosis takes highest priority for a female client with hyperthyroidism?
A
Body image disturbance related to weight gain and edema
B
Imbalanced nutrition: Less than body requirements related to thyroid hormone excess
C
Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing
D
Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess
Question 8 Explanation:
In the client with hyperthyroidism, excessive thyroid hormone production leads to hypermetabolism and increased nutrient metabolism. These conditions may result in a negative nitrogen balance, increased protein synthesis and breakdown, decreased glucose tolerance, and fat mobilization and depletion. This puts the client at risk for marked nutrient and calorie deficiency, making Imbalanced nutrition: Less than body requirements the most important nursing diagnosis.
Question 9
For the patient with hyperthyroidism, what intervention should you delegate to the experienced certified nursing assistant?
A
Draw blood for thyroid-stimulating hormone, T3, and T4 levels.
B
Check the apical pulse, blood pressure, and temperature every 4 hours.
C
Explain the side effects of propylthiouracil (PTU) to the patient.
D
Instruct the patient to report palpitations, dyspnea, vertigo, pr chest pain.
Question 9 Explanation:
Monitoring and recording vital signs are within the education scope of nursing assistants. An experienced nursing assistant should have been taught how to monitor the apical pulse. However, the nurse should observe the nursing assistant to be sure that she has mastered this skill. Instructing and teaching patients, as well as performing venipuncture for laboratory samples, are more suited to the educational scope of licensed nurses. In some facilities, an experienced nursing assistant may perform venipuncture, but only after special training. Focus: Delegation/supervision
Question 10
Matilda, with hyperthyroidism is to receive Lugol’s iodine solution before a subtotal thyroidectomy is performed. The nurse is aware that this medication is given to:
A
Block the formation of thyroxine by the thyroid gland.
B
Maintain the function of the parathyroid glands.
C
Decrease the size and vascularity of the thyroid gland.
D
Decrease the total basal metabolic rate.
Question 10 Explanation:
Lugol’s solution provides iodine, which aids in decreasing the vascularity of the thyroid gland, which limits the risk of hemorrhage when surgery is performed.
Question 11
Ms.Clark has hyperthyroidism and is scheduled for a thyroidectomy. The physician has ordered Lugol’s solution for the client. The nurse understands that the primary reason for giving Lugol’s solution preoperatively is to:
A
reduce the size and vascularity of the thyroid and prevent hemorrhage.
B
decrease the risk of agranulocytosis postoperatively.
C
potentiate the effect of the other preoperative medication so less medicine can be given while the client is under anesthesia.
D
prevent tetany while the client is under general anesthesia.
Question 11 Explanation:
Doses of over 30 mg/day may increase the risk of agranulocytosis. Lugol’s solution does not act to prevent tetany. Calcium is used to treat tetany. The client may receive iodine solution (Lugol’s solution) for 10 to 14 days before surgery to decrease vascularity of the thyroid and thus prevent excess bleeding. Lugol’s solution does not potentiate any other preoperative medication.
Question 12
Which medication will the nurse have available for emergency treatment of tetany in the client who has had thyroidectomy?
A
Magnesium chloride
B
Calcium chloride
C
Potassium chloride
D
Sodium bicarbonate
Question 13
Untreated hyperthyroidism during pregnancy may result in all of the following except:
A
Low birthweight
B
Premature birth and miscarriage
C
Autism
D
Preeclampsia
Question 13 Explanation:
In addition to the above-mentioned complications of uncontrolled hyperthyroidism in pregnancy, expectant mothers may suffer congestive heart failure and thyroid storm, which is life-threatening thyrotoxicosis with symptoms that include agitation, confusion, tachycardia, shaking, sweating, diarrhea, fever, and restlessness.
Question 14
The physician orders laboratory tests to confirm hyperthyroidism in a female client with classic signs and symptoms of this disorder. Which test result would confirm the diagnosis?
A
No increase in the thyroid-stimulating hormone (TSH) level after 30 minutes during the TSH stimulation test
B
A decreased TSH level
C
An increase in the TSH level after 30 minutes during the TSH stimulation test
D
Below-normal levels of serum triiodothyronine (T3) and serum thyroxine (T4) as detected by radioimmunoassay
Question 14 Explanation:
In the TSH test, failure of the TSH level to rise after 30 minutes confirms hyperthyroidism. A decreased TSH level indicates a pituitary deficiency of this hormone. Below-normal levels of T3 and T4, as detected by radioimmunoassay, signal hypothyroidism. A below-normal T4 level also occurs in malnutrition and liver disease and may result from administration of phenytoin and certain other drugs.
Question 15
A client is being returned after subtotal thyroidectomy. Which piece of equipment is most important for the nurse to keep at the client’s bedside?
A
Orange juice and hard candy
B
Indwelling catheter tray
C
Tracheostomy set
D
Cardiac monitor and oxygen tank
Question 15 Explanation:
After subtotal thyroidectomy, swelling of the surgical site ( the tracheal area) may obstruct the airway. Therefore tracheostomy set should be at the bedside in case of respiratory emergency.
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1) Which change in vital signs would you instruct a nursing assistant to report immediately for a patient with hyperthyroidism?
Increased and rapid heart rate
Decrease systolic blood pressure
Increased respiratory rate
Decreased oral temperature
2) For the patient with hyperthyroidism, what intervention should you delegate to the experienced certified nursing assistant?
Instruct the patient to report palpitations, dyspnea, vertigo, pr chest pain.
Check the apical pulse, blood pressure, and temperature every 4 hours.
Draw blood for thyroid-stimulating hormone, T3, and T4 levels.
Explain the side effects of propylthiouracil (PTU) to the patient.
3) Which nursing diagnosis takes highest priority for a client with hyperthyroidism?
Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess
Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing
Body image disturbance related to weight gain and edema
Imbalanced nutrition: Less than body requirements related to thyroid hormone excess
4) A 38 year old woman returns from a subtotal thryroidectomy for the treatment of hyperthyroidism. Upon assessment, the immediate priority that the nurse would include is:
Assess for pain
Assess for neurological status
Assess fluid volume status
Assess for respiratory distress
5) Which of the following nursing assessment is the most important in the patient with hyperthyroidism and risk for thyrotoxic crisis or thyroid storm?
Intake and output
Heart sounds
Bowel sounds
Vital signs
6) A client with hyperthyroidism is taking lithium carbonate to inhibit thyroid hormone release. Which complaint by the client should alert the nurse to a problem with the client’s medication?
The client complains of blurred vision.
The client complains of increased thirst and increased urination.
The client complains of increased weight gain over the past year.
The client complains of ringing in the ears.
7) Untreated hyperthyroidism during pregnancy may result in all of the following except:
Premature birth and miscarriage
Low birthweight
Autism
Preeclampsia
8) The physician orders laboratory tests to confirm hyperthyroidism in a female client with classic signs and symptoms of this disorder. Which test result would confirm the diagnosis?
No increase in the thyroid-stimulating hormone (TSH) level after 30 minutes during the TSH stimulation test
A decreased TSH level
An increase in the TSH level after 30 minutes during the TSH stimulation test
Below-normal levels of serum triiodothyronine (T3) and serum thyroxine (T4) as detected by radioimmunoassay
9) A client is being returned after subtotal thyroidectomy. Which piece of equipment is most important for the nurse to keep at the client’s bedside?
Orange juice and hard candy
Tracheostomy set
Cardiac monitor and oxygen tank
Indwelling catheter tray
10) Which medication will the nurse have available for emergency treatment of tetany in the client who has had thyroidectomy?
Calcium chloride
Potassium chloride
Magnesium chloride
Sodium bicarbonate
11) Matilda, with hyperthyroidism is to receive Lugol’s iodine solution before a subtotal thyroidectomy is performed. The nurse is aware that this medication is given to:
Decrease the total basal metabolic rate.
Maintain the function of the parathyroid glands.
Block the formation of thyroxine by the thyroid gland.
Decrease the size and vascularity of the thyroid gland.
12) Which nursing diagnosis takes highest priority for a female client with hyperthyroidism?
Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess
Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing
Body image disturbance related to weight gain and edema
Imbalanced nutrition: Less than body requirements related to thyroid hormone excess
13) Ms.Clark has hyperthyroidism and is scheduled for a thyroidectomy. The physician has ordered Lugol’s solution for the client. The nurse understands that the primary reason for giving Lugol’s solution preoperatively is to:
decrease the risk of agranulocytosis postoperatively.
prevent tetany while the client is under general anesthesia.
reduce the size and vascularity of the thyroid and prevent hemorrhage.
potentiate the effect of the other preoperative medication so less medicine can be given while the client is under anesthesia.
14) What are the functions of T3 and T4?
Retention of salt and water
Maintenance of blood sugar
Maintenance of blood pressure
Regulation of energy production
15) A patient is admitted to the medical unit with possible Graves’ disease (hyperthyroidism). Which assessment finding supports this diagnosis?
Periorbital edema
Bradycardia
Exophthalmos
Hoarse voice
Answers and Rationales
A. Increased and rapid heart rate . The cardiac problems associated with hyperthyroidism include tachycardia, increased systolic blood pressure, and decreased diastolic blood pressure. Patients with hyperthyroidism also may have increased body temperature related to increased metabolic rate. Focus: Delegation/supervision
B. Check the apical pulse, blood pressure, and temperature every 4 hours. Monitoring and recording vital signs are within the education scope of nursing assistants. An experienced nursing assistant should have been taught how to monitor the apical pulse. However, the nurse should observe the nursing assistant to be sure that she has mastered this skill. Instructing and teaching patients, as well as performing venipuncture for laboratory samples, are more suited to the educational scope of licensed nurses. In some facilities, an experienced nursing assistant may perform venipuncture, but only after special training. Focus: Delegation/supervision
D. Imbalanced nutrition: Less than body requirements related to thyroid hormone excess . In the client with hyperthyroidism, excessive thyroid hormone production leads to hypermetabolism and increased nutrient metabolism. These conditions may result in a negative nitrogen balance, increased protein synthesis and breakdown, decreased glucose tolerance, and fat mobilization and depletion. This puts the client at risk for marked nutrient and calorie deficiency, making Imbalanced nutrition: Less than body requirements the most important nursing diagnosis.
D. Assess for respiratory distress . Though fluid volume status, neurological status and pain are all important assessment, the immediate priority for postoperative is the airway management. Respiratory distress may result from hemorrhage, edema, laryngeal damage or tetany.
D. Vital signs
B. The client complains of increased thirst and increased urination. Increased thirst and increased urination are signs of lithium toxicity.
C. Autism . In addition to the above-mentioned complications of uncontrolled hyperthyroidism in pregnancy, expectant mothers may suffer congestive heart failure and thyroid storm, which is life-threatening thyrotoxicosis with symptoms that include agitation, confusion, tachycardia, shaking, sweating, diarrhea, fever, and restlessness.
A. No increase in the thyroid-stimulating hormone (TSH) level after 30 minutes during the TSH stimulation test . In the TSH test, failure of the TSH level to rise after 30 minutes confirms hyperthyroidism. A decreased TSH level indicates a pituitary deficiency of this hormone. Below-normal levels of T3 and T4, as detected by radioimmunoassay, signal hypothyroidism. A below-normal T4 level also occurs in malnutrition and liver disease and may result from administration of phenytoin and certain other drugs.
B. Tracheostomy set . After subtotal thyroidectomy, swelling of the surgical site ( the tracheal area) may obstruct the airway. Therefore tracheostomy set should be at the bedside in case of respiratory emergency.
B. Potassium chloride
D. Decrease the size and vascularity of the thyroid gland. Lugol’s solution provides iodine, which aids in decreasing the vascularity of the thyroid gland, which limits the risk of hemorrhage when surgery is performed.
D. Imbalanced nutrition: Less than body requirements related to thyroid hormone excess . In the client with hyperthyroidism, excessive thyroid hormone production leads to hypermetabolism and increased nutrient metabolism. These conditions may result in a negative nitrogen balance, increased protein synthesis and breakdown, decreased glucose tolerance, and fat mobilization and depletion. This puts the client at risk for marked nutrient and calorie deficiency, making Imbalanced nutrition: Less than body requirements the most important nursing diagnosis.
C. reduce the size and vascularity of the thyroid and prevent hemorrhage. Doses of over 30 mg/day may increase the risk of agranulocytosis. Lugol’s solution does not act to prevent tetany. Calcium is used to treat tetany. The client may receive iodine solution (Lugol’s solution) for 10 to 14 days before surgery to decrease vascularity of the thyroid and thus prevent excess bleeding. Lugol’s solution does not potentiate any other preoperative medication.
D. Regulation of energy production
C. Exophthalmos . Exophthalmos (abnormal protrusion of the eye) is characteristic of patients with hyperthyroidism due to Graves’ disease. Periorbital edema, bradycardia, and hoarse voice are all characteristics of patients with hypothyroidism. Focus: Prioritization