A nurse is preparing a client for a lumbar puncture. Which position should the nurse place the client in to facilitate the procedure?

Choice A reason: Hyperchloremia, elevated chloride levels, is associated with metabolic acidosis or dehydration, not neuromuscular symptoms like wrist flexion. Chloride imbalances affect acid-base balance, not calcium-dependent muscle contractions. The inward wrist flexion suggests a neuromuscular excitability issue, which is more characteristic of low calcium levels than chloride abnormalities.

Choice B reason: Hypercalcemia, high calcium levels, causes muscle weakness, lethargy, and reduced reflexes, not increased neuromuscular excitability like wrist flexion. Calcium excess stabilizes nerve membranes, reducing spasms. The symptom described aligns with hypocalcemia, where low calcium increases nerve excitability, leading to tetany or abnormal muscle contractions.

Choice C reason: Hypocalcemia, low calcium levels, increases neuromuscular excitability due to decreased stabilization of nerve membranes. This can cause tetany, characterized by involuntary muscle contractions, such as wrist flexion (carpopedal spasm). The symptom is a classic sign of hypocalcemia, often seen in conditions like hypoparathyroidism or vitamin D deficiency.

Choice D reason: Hypomagnesemia, low magnesium, can cause neuromuscular symptoms like tremors or seizures but is less commonly associated with specific signs like wrist flexion. Magnesium affects muscle relaxation, and its deficiency typically causes generalized excitability. Hypocalcemia is more directly linked to tetany and carpopedal spasms, as seen in the client.

Choice A reason: Weight gain is associated with hypothyroidism, not hyperthyroidism. Hyperthyroidism increases metabolic rate, leading to weight loss due to increased calorie expenditure. The thyroid hormones accelerate metabolism, causing catabolism, which contrasts with the client’s likely symptom of weight loss, not gain, in hyperthyroidism.

Choice B reason: Bradycardia, or slow heart rate, occurs in hypothyroidism due to decreased metabolic rate. Hyperthyroidism causes tachycardia, as elevated thyroid hormones increase sympathetic activity, raising heart rate and cardiac output. The client’s symptoms would likely include a rapid heart rate, not bradycardia, in this condition.

Choice C reason: Heat intolerance is a classic symptom of hyperthyroidism due to increased metabolic rate from elevated thyroid hormones. This causes excessive heat production, leading to sweating and discomfort in warm environments. The symptom aligns with the hypermetabolic state, making it the most likely to be reported.

Choice D reason: Constipation is associated with hypothyroidism, where decreased metabolism slows gastrointestinal motility. Hyperthyroidism increases motility, often causing diarrhea. The client with hyperthyroidism is unlikely to report constipation, as their condition accelerates digestive processes, contrasting with the slowed motility seen in hypothyroidism.