AIIMS Delhi NO - 2018
Medical & Surgical Nursing
Easy
A nurse is measuring the blood pressure of a patient, and the patient complains of carpal spasm. Which condition may be occurring?
Appeared in: AIIMS Delhi NO - 2018
Explanation
- The patient's symptom of carpal spasm during blood pressure measurement is a classic clinical finding known as Trousseau's sign.
- Trousseau's sign is elicited by inflating a sphygmomanometer cuff above systolic pressure for several minutes, which induces ischemia and triggers a carpal spasm in patients with latent tetany.
- This sign is highly specific for hypocalcemia (a serum calcium level below 8.6 mg/dL).
- Hypocalcemia increases neuromuscular excitability, leading to spontaneous discharges of sensory and motor nerves, which results in spasms and tetany.
Why Other Options Were Wrong
- Option A: Hypercalcemia (high calcium levels) causes decreased neuromuscular excitability, leading to symptoms like muscle weakness, fatigue, and lethargy, which is the opposite of the tetany seen in the patient.
- Option B: Hyperkalemia (high potassium levels) is primarily associated with cardiac arrhythmias (like peaked T-waves on an ECG) and generalized muscle weakness or paralysis, not the localized carpal spasms characteristic of Trousseau's sign.
- Option D: While severe hypomagnesemia can also cause neuromuscular excitability and tetany, it is a less direct cause. Hypomagnesemia often leads to hypocalcemia by impairing parathyroid hormone (PTH) secretion and action. Trousseau's sign is the direct clinical indicator for the resulting hypocalcemia.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to Assessment of Electrolyte Imbalances to guide bedside assessment, documentation, and the next nursing action.
- Prompt recognition of Trousseau's sign is a critical nursing skill for the early detection of hypocalcemia.
- Untreated severe hypocalcemia can progress to life-threatening complications, including laryngeal spasms (which can obstruct the airway), seizures, and cardiac arrhythmias (prolonged QT interval).
- Nurses should anticipate hypocalcemia in at-risk patients, such as those who have had thyroid or parathyroid surgery, patients with pancreatitis, or those with chronic kidney disease.
How to Approach the Question
- First, identify the key clinical event described in the question: a patient develops a 'carpal spasm' specifically while their 'blood pressure is being measured'.
- Recognize this specific event as a named clinical sign. This is the classic description of Trousseau's sign.
- Recall the primary electrolyte imbalance associated with Trousseau's sign.
- Connect Trousseau's sign to hypocalcemia, which is characterized by increased neuromuscular excitability (latent tetany).
- Evaluate the given options and select the one that matches your conclusion.
- Differentiate from other electrolyte imbalances by recalling their primary manifestations (e.g., weakness in hypercalcemia/hyperkalemia).
Concept Tested & Keywords
- Concept Tested: Assessment of Electrolyte Imbalances
- Stem keywords: measuring blood pressure, carpal spasm
- Lead-in keywords: Which condition
- Clinical cues: The combination of a routine procedure (BP measurement) triggering a specific symptom (carpal spasm) is a classic presentation of a named clinical sign.
- Negative lead-in flag: false
Question ID
Qaf4HxiN0M7QDb7udiIsoZ
Reference Book
E6 Nursing Brunner Adult Health 3SA Vol 1 Part 1 p. 153-155
E6 Medicine Davidson Principles Practice 24e p. 683-685
E6 Medicine Harrison 22e Part 2 p. 1190-1192
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