# A nurse is assessing a client 6 hours after total thyroidectomy. Which findings require immediate provider notification? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375018&lang=en  
> language: en  
> subject: Psychosocial Integrity  
> category: PSI

## Question

A nurse is assessing a client 6 hours after total thyroidectomy. Which findings require immediate provider notification? Select all that apply.

1

Positive Chvostek and Trousseau signs with circumoral numbness

2

Mild incisional discomfort relieved by ordered acetaminophen

3

Visible neck swelling extending the dressing with stridor

4

Sudden temperature 39.8 C with HR 152 and agitation

5

Inability to make any sound or whisper after extubation

## Explanation

Postoperative thyroidectomy emergencies: (1) Neck hematoma compressing the airway — visible swelling and stridor demand bedside opening of the wound to release blood. (2) Hypocalcemic tetany from inadvertent parathyroid injury — Chvostek/Trousseau and perioral numbness need IV calcium gluconate. (3) Bilateral recurrent laryngeal nerve injury produces complete aphonia and risk of airway obstruction; unilateral injury causes hoarseness. (4) Thyroid storm rarely occurs in well-prepared patients but high fever and tachycardia mandate emergent treatment. Mild incisional pain controlled by ordered analgesia is expected.

## In-depth explanation

Bedside emergency tray: tracheostomy and suture removal kit. Open the wound and evacuate hematoma BEFORE airway is lost.

## Clinical scenario

Postop thyroidectomy. Pre-op calcium normal. Voice slightly hoarse but improving since extubation.

## Key concepts

- **Chvostek sign** — Facial twitch on tapping the cheek over the facial nerve; sign of hypocalcemia.
- **Trousseau sign** — Carpal spasm with BP cuff inflation above systolic for 3 minutes; hypocalcemia.
- **recurrent laryngeal nerve** — Branch of vagus innervating vocal cord adduction; injury causes hoarseness or aphonia.

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