After a total thyroidectomy, a client reports perioral tingling, has a positive Chvostek sign, and then develops stridor. Complete the emergency response.
Drop-down Cloze
Choose your responses, then check the answer.
Explanation
Perioral tingling and Chvostek sign after thyroidectomy suggest acute hypocalcemia; stridor signals possible laryngospasm and airway compromise. Activate urgent help, support airway and breathing, and prepare prescribed IV calcium gluconate with ECG monitoring while calcium and contributing abnormalities are assessed.
Quick answer Recognize symptomatic acute hypocalcemia with possible laryngospasm, activate urgent airway support, and prepare prescribed IV calcium gluconate with ECG monitoring and electrolyte assessment.
Why this is correct Thyroid surgery can disrupt parathyroid function. Perioral tingling and Chvostek sign show neuromuscular irritability, and new stridor makes the problem an airway emergency rather than a routine laboratory abnormality.
Easy analogy or mental picture Falling calcium makes nerves and muscles electrically overactive; when the laryngeal muscles tighten, the airway can narrow quickly.
Memory hook Tingling, twitching, then stridor after thyroid surgery: airway and IV calcium now.
NCLEX decision rule Stridor always elevates airway action. Symptomatic severe hypocalcemia requires urgent calcium replacement as prescribed, ECG monitoring during IV administration, and evaluation of calcium, magnesium, and the underlying cause.
Why the other choices are wrong Routine observation, oral-only treatment, ambulation, or waiting for morning rounds delays care for possible laryngospasm and respiratory deterioration.
Source
1Society for Endocrinology Acute Hypocalcaemia Emergency Guidance
2Society for Endocrinology Clinical Guidance
32026 NCLEX-RN Test Plan
The nurse remains with the client, activates urgent assistance, and supports airway and breathing. Emergency calcium replacement and monitoring resources are available according to the prescribed protocol.
Acute hypocalcemia — A rapid fall in ionized calcium that can cause neuromuscular irritability, seizures, laryngospasm, and cardiac electrical changes.
Chvostek sign — Facial muscle contraction after tapping the facial nerve, a finding that can accompany hypocalcemic neuromuscular irritability.
Laryngospasm — Involuntary closure of the vocal cords that can cause stridor and rapidly impair ventilation.