NCLEX-RNManagement of CareMedium
A nurse is caring for four clients at the start of the shift. Which client should the nurse assess first?
- AA client with a chest tube whose drainage has decreased from 100 mL/hr to 20 mL/hr
- BA client with a fractured femur whose pain is rated 8/10 after receiving analgesia 30 minutes ago
- CA client 1 day post-thyroidectomy who reports tingling around the mouth
- DA client with pneumonia whose oxygen saturation is 94% on 2 L nasal cannula
Show answer & explanationAnswer & explanation
Correct answer: C. A client 1 day post-thyroidectomy who reports tingling around the mouth
Perioral tingling after thyroidectomy suggests hypocalcemia from accidental parathyroid injury, which can progress to laryngospasm and airway compromise—an airway emergency. The other findings (decreased chest tube drainage may be normal resolution, uncontrolled pain, and mild hypoxemia at 94%) are important but less immediately life-threatening.
Why the other options are wrong
- A. Decreased chest tube drainage over time can be a normal finding, not urgent.
- B. Pain needing reassessment is important but not immediately life-threatening.
- D. 94% on 2L is mildly low but not an emergent airway/breathing crisis.
Post-Thyroidectomy Hypocalcemia
Accidental removal or injury of parathyroid glands during thyroidectomy causes hypocalcemia, presenting as perioral tingling, muscle twitching (Chvostek/Trousseau signs), and risk of laryngospasm.
- Signs: perioral/finger tingling, muscle cramps, Chvostek's/Trousseau's sign
- Can progress to laryngospasm and airway obstruction—emergency
- Keep IV calcium gluconate at bedside for postop thyroidectomy clients
Memory trick: Tingling lips post-thyroid = airway alarm