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

Answer and Explanation

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.

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Correct Answer is D

Explanation

A. Apply water-soluble lubricant to the site. Lubricants are not necessary for gastrostomy tube site care. Instead, the nurse should keep the area clean and dry to prevent irritation and infection. Applying lubricant could increase moisture, potentially leading to skin breakdown or fungal infections.
B. Attach an extension tube to the site's opening prior to use. Extension tubes are only needed for certain types of gastrostomy devices, such as low-profile buttons, and should be attached only when feeding or administering medications. Continuous attachment is unnecessary and may increase the risk of dislodgment or contamination.
C. Tape the tube to the child's cheek. Taping a gastrostomy tube to the cheek is inappropriate, as it does not provide adequate stabilization and may cause discomfort. This technique is more commonly used for securing nasogastric tubes rather than gastrostomy tubes.
D. Secure the tubing to the child's abdomen. Properly securing the gastrostomy tube to the abdomen helps prevent accidental dislodgment, irritation, and skin breakdown. The tube should be secured with tape or a securement device while allowing slight movement to reduce tension on the insertion site.

A. "Request that the nurses show their nursing license prior to removing your newborn from the room." B. "Leave your newborn in the bassinet in your room while you use the bathroom." C. "Alert the staff if any of your newborn's identification-bands are missing." D. "Carry your newborn back to the nursery in your arms when you need to rest."

Correct Answer is C

Explanation

A. "Request that the nurses show their nursing license prior to removing your newborn from the room." While it's important to ensure that only authorized personnel handle the newborn, asking for nursing licenses is not practical and may not be feasible in a busy clinical environment. Instead, parents should be encouraged to verify the identity of staff based on hospital protocols.
B. "Leave your newborn in the bassinet in your room while you use the bathroom." Leaving the newborn unattended, even in the bassinet, is not advisable. Parents should take their newborn with them if possible or ask for help from staff to ensure the baby's safety while they are away.
C. "Alert the staff if any of your newborn's identification bands are missing." Alerting staff about missing identification bands is crucial for the safety of the newborn. Identification bands help prevent abductions and ensure that the correct infant is returned to the right mother. Parents should be vigilant and report any issues immediately.
D. "Carry your newborn back to the nursery in your arms when you need to rest." Carrying the newborn back to the nursery is not recommended for safety reasons. If the parent needs to rest, they should ask the staff to take the baby to the nursery instead, allowing for proper handling and minimizing the risk of falls or accidents.

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A nurse is monitoring a client who was admitted for hypocalcemia. Which of the following findings should the nurse expect?

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