A nurse is monitoring a client who was admitted for hypocalcemia. Which of the following findings should the nurse expect?
Positive Chvostek's sign
Hypotension
Confusion
Positive Babinski reflex
The Correct Answer is A
A. Positive Chvostek's sign. Hypocalcemia increases neuromuscular excitability, leading to involuntary twitching of facial muscles when the facial nerve is tapped. This sign is a well-known indicator of calcium deficiency and reflects heightened nerve sensitivity.
B. Hypotension. While severe hypocalcemia can affect cardiovascular function, hypotension is not a primary or consistent finding. More commonly, calcium imbalances affect muscle contractions rather than directly causing low blood pressure.
C. Confusion. Hypocalcemia can cause neurological symptoms, but confusion is more common in severe or prolonged cases. Early manifestations are usually neuromuscular, such as tetany or muscle cramps, rather than cognitive impairment.
D. Positive Babinski reflex. This reflex is associated with upper motor neuron dysfunction and neurological disorders rather than electrolyte imbalances like hypocalcemia. Calcium deficiency primarily affects peripheral nerves and muscle excitability.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Encourage the client to use the overbed trapeze. Using an overbed trapeze helps the client build upper body strength, which is essential for mobility and independence following an amputation. Strengthening the arms and shoulders facilitates bed mobility, transfers, and eventual prosthetic use.
B. Keep a loose, absorbent dressing over the client's surgical site. The surgical site should be covered with a secure, sterile dressing to promote healing and prevent infection. Loose dressings can shift, increasing the risk of contamination and delayed wound healing.
C. Maintain abduction of the client's residual limb with a pillow. Prolonged abduction is not recommended, as it can lead to hip contractures. The limb should be kept in a neutral or slightly extended position to maintain proper alignment and prevent muscle shortening that could interfere with prosthetic use.
D. Caution the client to avoid a prone position while in bed. Prone positioning is actually encouraged intermittently to help stretch the hip flexors and prevent contractures. Avoiding this position may increase the risk of hip flexion contractures, making prosthetic fitting and ambulation more difficult.
Correct Answer is A
Explanation
A. Physicians' Desk Reference (PDR). The PDR is a comprehensive drug reference that provides essential information on medications, including indications, dosages, contraindications, adverse effects, and interactions. It is a reliable resource for nurses to review before administering an unfamiliar medication.
B. State Nurse Practice Act (NPA). The NPA defines the scope of nursing practice and legal responsibilities but does not provide specific drug information. While it guides nurses on legal and ethical aspects of medication administration, it is not a medication reference.
C. Agency for Healthcare Research and Quality (AHRQ). AHRQ focuses on improving healthcare quality and patient safety but does not serve as a primary source for drug-specific information. It provides guidelines and research on best practices rather than detailed medication data.
D. Quality and Safety Education for Nurses (QSEN). QSEN aims to improve nursing education and competency in patient safety but does not offer detailed drug reference materials. It emphasizes principles such as evidence-based practice and quality improvement rather than specific medication details.
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