A nurse is caring for a client following a thyroidectomy. The nurse should assess for which of the following findings as an indication of hypocalcemia?
Strong bounding pulse
Diminished deep tendon reflexes
Tingling and numbness of the hands and feet
Decreased bowel sounds
The Correct Answer is C
A. Strong bounding pulse: A bounding pulse is more commonly associated with hypervolemia or hyperthyroidism rather than hypocalcemia. It does not reflect the neuromuscular excitability seen with low calcium levels.
B. Diminished deep tendon reflexes: Hypocalcemia typically causes hyperreflexia or positive Chvostek and Trousseau signs due to increased neuromuscular excitability, rather than diminished reflexes.
C. Tingling and numbness of the hands and feet: Paresthesia in the extremities is a classic early sign of hypocalcemia. Low calcium increases neuromuscular excitability, leading to tingling, numbness, and muscle cramps.
D. Decreased bowel sounds: Hypocalcemia does not directly affect gastrointestinal motility in the acute setting. Decreased bowel sounds are more related to medications, ileus, or other electrolyte imbalances such as hypermagnesemia.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Hypovolemic shock, Stage I: Hypovolemic shock results from fluid loss (e.g., hemorrhage or dehydration) and usually presents with hypotension and tachycardia, but the context of severe chest pain and coronary artery disease makes hypovolemia less likely as the primary cause.
B. Neurogenic shock, Stage I: Neurogenic shock typically occurs after spinal cord injury, presenting with hypotension and bradycardia. This patient is tachycardic and anxious, making neurogenic shock unlikely.
C. Septic shock, Stage III: Septic shock is associated with infection and systemic inflammatory response. While hypotension is present, there is no indication of infection, fever, or leukocytosis, and the onset is acute rather than gradual.
D. Cardiogenic shock, Stage II: Cardiogenic shock arises from inadequate cardiac output, often due to acute myocardial infarction. The patient’s hypotension, tachycardia, weak thready pulse, cool clammy skin, shallow breathing, decreased urine output, and history of coronary artery disease indicate Stage II (compensatory) cardiogenic shock.
Correct Answer is A
Explanation
A. NIH Stroke Scale: The National Institutes of Health Stroke Scale (NIHSS) is used to assess the severity of neurological deficits in stroke patients. It evaluates level of consciousness, language, visual fields, motor function, and sensory abilities, providing a standardized score to guide treatment decisions and monitor progression.
B. Cincinnati Stroke Scale: The Cincinnati Prehospital Stroke Scale is a quick screening tool used by emergency responders to identify possible strokes in the field. It assesses facial droop, arm drift, and speech abnormalities but does not quantify stroke severity.
C. Glasgow Outcome Scale: The Glasgow Outcome Scale measures functional recovery and long-term outcomes after brain injury, not the acute severity of stroke symptoms at presentation.
D. Hemorrhage Scale: Hemorrhage scales, such as the Fisher scale, are used to grade the extent of bleeding on imaging studies. They do not provide a structured assessment of neurological deficits in acute stroke patients.
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