A nurse is caring for a client who has hypocalcemia. Which of the following findings should the nurse expect?
Muscle flaccidity
Lethargy
Constipation
Positive Chvostek's sign
The Correct Answer is D
A. Muscle flaccidity: Hypocalcemia typically causes muscle twitching or spasms, not flaccidity. Muscle flaccidity is more often associated with conditions like hyperkalemia or electrolyte imbalances affecting muscle tone in different ways.
B. Lethargy: Lethargy can occur in various conditions, but it is not a hallmark of hypocalcemia. Instead, hypocalcemia usually causes symptoms like irritability, confusion, and muscle cramps rather than general lethargy.
C. Constipation: Constipation is more commonly associated with hypercalcemia, not hypocalcemia. Low calcium levels tend to cause neuromuscular and cardiac symptoms rather than gastrointestinal issues like constipation.
D. Positive Chvostek's sign: A positive Chvostek's sign, which is a twitching of the facial muscles when tapping the facial nerve, is a classic sign of hypocalcemia. It indicates increased neuromuscular excitability, which is characteristic of low calcium levels.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Bathe the client with soap and hot water: Hot water and soap can dry out the skin and worsen skin breakdown. The nurse should use lukewarm water and mild soap to prevent skin irritation, ensuring proper hydration and skin care.
B. Massage bony prominences four times daily: Massaging bony prominences can increase the risk of skin breakdown, as it may cause further tissue damage. Instead, the nurse should avoid massaging these areas and focus on preventive measures, such as repositioning.
C. Keep the head of the client's bed at 30° or less: Keeping the head of the bed at a 30° angle or less reduces pressure on the sacrum and other bony prominences. This position helps prevent further skin breakdown and promotes comfort for immobile clients.
D. Slide the client up in bed every 2 hr: Sliding the client up in bed increases friction, which can exacerbate skin breakdown. The nurse should use proper lifting techniques or assistive devices to reposition the client while minimizing friction and shearing forces.
Correct Answer is A
Explanation
A. Occupational therapist: An occupational therapist specializes in helping clients with activities of daily living (ADLs), such as dressing, grooming, and bathing. An occupational therapist can assist in creating strategies or using adaptive equipment to help the client become more independent with dressing.
B. Respiratory therapist: A respiratory therapist focuses on managing respiratory issues and providing treatments like oxygen therapy or breathing exercises. This is not directly related to assisting with dressing, so they are not the appropriate team member for this issue.
C. Social worker: While a social worker can assist with psychosocial issues and discharge planning, they are not typically involved in helping with daily functional tasks like dressing. They would not be the primary provider for this need.
D. Physical therapist: A physical therapist focuses on improving movement, strength, and mobility, particularly related to walking and physical rehabilitation. While they may assist with mobility following surgery, they are not primarily focused on ADLs like dressing.
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