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While performing an assessment of the integument system, the nurse notes the client's eyeballs are protruding and the upper eyelids are elevated. What term should the nurse use to document this finding?

A. Erythema
B. Cyanosis
C. Exophthalmos
D. Normocephalic

Answer :

Final answer:

The term 'Exophthalmos' should be used to document a condition involving protruding eyeballs and elevated upper eyelids. This could be indicative of Graves disease but may be related to other health issues as well.

Explanation:

The correct term that the nurse should use to document the protruding eyeballs and the elevated upper eyelids condition is Exophthalmos. Exophthalmos is related to various health conditions.

One of the most common being Graves disease, as noted by the reference information provided. The condition, also known as Graves ophthalmopathy, causes inflammation and other immune system events that lead to eye protrusion.

The nurse could define this condition more specifically as 'Graves ophthalmopathy' if it's confirmed that the patient has Graves disease. However, in the absence of this confirmation, the general term 'Exophthalmos' is appropriate to describe the observed eye protrusion.

Learn more about Exophthalmos here:

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