SJH Nursing Officer - 2019
Medical & Surgical Nursing
Easy
The condition in the below image is caused by-
Appeared in: SJH Nursing Officer - 2019
Explanation
- The image displays Trousseau's sign, a specific type of muscle spasm known as carpopedal spasm.
- Trousseau's sign is a classic and more specific indicator of hypocalcemia (low serum calcium levels) compared to other signs.
- Hypocalcemia increases the excitability of nerve membranes, leading to spontaneous discharges of sensory and motor nerve fibers, which results in tetany and muscle spasms.
- This sign can be elicited by temporarily occluding arterial blood flow to the arm, which induces ischemia and triggers the spasm in susceptible individuals.
Why Other Options Were Wrong
- Option A: Hypokalemia (low potassium) primarily causes muscle weakness, fatigue, and cardiac arrhythmias. It does not cause the tetany and carpopedal spasm seen in the image.
- Option B: Hyperkalemia (high potassium) leads to muscle weakness or paralysis and significant cardiac conduction abnormalities, such as peaked T waves and widened QRS complexes, not tetany.
- Option D: Hypercalcemia (high calcium) decreases neuromuscular excitability. Its symptoms are often remembered by the mnemonic 'stones, bones, groans, and moans' (kidney stones, bone pain, abdominal pain, and psychiatric disturbances), along with muscle weakness.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Identification of Trousseau's sign and its underlying cause as background academic context rather than a clinical decision trigger.
- Recognizing Trousseau's sign is a critical nursing skill, as it indicates latent tetany due to severe hypocalcemia, which can progress to life-threatening laryngospasm and seizures if not treated promptly.
- Nurses should closely monitor patients at risk for hypocalcemia, such as those who have undergone thyroid or parathyroid surgery, patients with pancreatitis, or those receiving massive blood transfusions with citrated blood.
- What if? If the patient in the image also complained of numbness and tingling around the mouth (circumoral paresthesia) and in the fingertips, it would further strengthen the diagnosis of hypocalcemia, as these are common early sensory symptoms.
How to Approach the Question
- First, carefully analyze the image to identify the clinical sign being displayed. The image shows a characteristic hand spasm.
- Recognize this specific posture (flexed wrist and MCP joints, extended IP joints, adducted thumb) as carpopedal spasm, also known as Trousseau's sign.
- Recall the common causes of tetany and Trousseau's sign. This sign is a hallmark of increased neuromuscular excitability.
- Evaluate the given electrolyte imbalances. Hypocalcemia is the primary cause of tetany.
- Differentiate from the other options: Hypokalemia and hyperkalemia typically cause muscle weakness, while hypercalcemia causes decreased neuromuscular excitability.
- Select Hypocalcemia as the correct cause based on the classic presentation of Trousseau's sign.
Concept Tested & Keywords
- Concept Tested: Identification of Trousseau's sign and its underlying cause.
- Stem keywords: image, condition, caused by
- Lead-in keywords: caused by
- Clinical cues: The visual presentation of carpopedal spasm is a specific clinical sign.
Question ID
QF7RcfImlQgeWSY3VbzYjx
Reference Book
E6 Nursing Brunner Adult Health 3SA Vol 1 Part 1 p. 153-155
E6 Medicine Harrison 22e Part 2 p. 1190-1192
E6 Medicine Davidson Principles Practice 24e p. 683-685
Practise the full SJH Nursing Officer - 2019
Attempt every question from this paper in a timed mock, then review the full solution for each one.
More Fluid and Electrolytes: Balance and Distribution Questions
- All are crystalloid solution; except:
- ECG of the patient is showing ST depression, Prominent U wave and inverted T wave. Which of the electrolyte imbalance present?
- A patient reports calcium loss. What is the nursing intervention?
- The principle of hemodialysis in which the water is moving under high pressure to an area of lower pressure is:
- Measurement of arterial blood gas shows pH: 7.2, PaCO2 : 70 mm Hg, HCO3: 27 mmol/L and PaO2: 59 mm Hg. Interpret this:
- Fluid volume deficit or hypovolemia describes the loss of
- A patient presents to the emergency department with a serum pH of 7.25, pCO2 of 40 mmHg, HCO3 of 22 mEq/L, sodium of 150 mEq/L, and chloride of 100 m…
- A 65-year-old patient is admitted to the hospital with a serum sodium level of 132 mmol/L. Despite being asymptomatic at admission, the patient begin…
- You are assessing a patient who is experiencing hyperventilation, resulting in a below-normal carbon dioxide (CO2) level. The patient is exhibiting s…
- A patient undergoes nasogastric suctioning for several days. Which electrolyte imbalance is most likely to occur due to this treatment?
More SJH Nursing Officer - 2019 Questions
- Tissues form lactic acid from glucose. This phenomenon is termed as?
- A prenatal client with a history of migraine headache has been instructed on care at home. Which statement if made by the client would indicate that…
- A contraction stress test is scheduled for the pregnant client and the client asks the nurse about the test. The nurse tells the client that?
- A Client is scheduled for a pap smear. The nurse provides instructions to the client regarding preparation for the test?
- The nurse is teaching a pregnant client about the morning sickness in pregnancy. Which of the following sign & symptom would indicate a need for furt…
- A nurse needs to check the most important parameter if patient is on magnesium sulphate therapy?
- When performing a postpartum assessment on a patient, a nurse notes the presence of clots in the lochia. The nurse examines the clots and notes that…
- A nurse in a labor room is performing a vaginal assessment on a pregnant patient in labor. The nurse notes the presence of the umbilical cord protrud…
- Which muscle present in anterior aspect of thigh?
- Nature of illness, characteristics comes under which types of variable?