A nurse is assessing a client who has hypocalcemia. Which of the following findings should the nurse expect? (Select all that apply.)

Positive Trousseau's sign

Muscle cramps

Tingling sensation around the lips

Negative Chvostek's sign

Abdominal distention

Answer and Explanation

Correct Answer : A,B,C

A. Positive Trousseau's sign: A positive Trousseau’s sign (carpal spasm induced by inflating a blood pressure cuff) is a classic indicator of hypocalcemia due to increased neuromuscular excitability.
B. Muscle cramps: Hypocalcemia leads to increased nerve excitability, causing muscle cramps, spasms, and tetany.
C. Tingling sensation around the lips: This is a common early sign of hypocalcemia, known as perioral paresthesia, due to increased nerve excitability.
D. Negative Chvostek's sign: A client with hypocalcemia would have a positive Chvostek’s sign, which is facial twitching when the facial nerve is tapped.
E. Abdominal distention: Hypocalcemia is more associated with diarrhea and hyperactive bowel sounds, not abdominal distention, which is more typical of hypokalemia.

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Correct Answer is A

Explanation

A. Request a referral for an occupational therapist. An occupational therapist (OT) can help the client maintain independence by teaching adaptive techniques and providing assistive devices for ADLs, such as dressing, bathing, and eating.
B. Request a home health aide to perform the client's ADLs for them. While a home health aide can assist with ADLs, the goal is to promote independence, not to have someone do everything for the client.
C. Instruct family members to place the client in a nursing home. Placement in a nursing home is a complex decision based on multiple factors. The nurse should focus on interventions to support the client at home before considering long-term care.
D. Contact the client's pharmacy to change their medication doses. Nurses do not have the authority to change medication doses. Medication adjustments should be discussed with the prescribing provider if needed.

A. Place multiple smoke detectors in the same area of the home. B. Change the batteries in smoke detectors every 2 years. C. Cover the nose and mouth with a damp cloth before exiting a smoke-filled area. D. Open a window to let smoke out before leaving the home.

Correct Answer is C

Explanation

A. Place multiple smoke detectors in the same area of the home. Smoke detectors should be placed in different areas, especially near bedrooms, in hallways, and on every level of the home, rather than clustering them in one area.
B. Change the batteries in smoke detectors every 2 years. Batteries should be changed at least once a year, and the smoke detector should be tested monthly to ensure functionality.
C. Cover the nose and mouth with a damp cloth before exiting a smoke-filled area. Using a damp cloth helps filter out some smoke and toxic fumes, reducing inhalation of harmful particles.
D. Open a window to let smoke out before leaving the home. Opening a window can increase oxygen flow, which may intensify the fire rather than help in an evacuation. Instead, the priority should be to evacuate immediately and call emergency services.

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A nurse is assessing a client who has hypocalcemia. Which of the following findings should the nurse expect? (Select all that apply.)

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