The nurse interprets a positive Homans sign as

KGMU 2024

Medical & Surgical Nursing

Easy

Appeared in: KGMU 2024

Explanation

A positive Homans' sign is characterized by pain in the calf or popliteal region upon forced dorsiflexion of the foot with the knee extended.
This sign is a classic, though now considered less reliable, indicator for Deep Venous Thrombosis (DVT).
The pain is caused by the stretching of the posterior tibial vein and surrounding inflamed tissues where a thrombus has formed.
While not definitive, it serves as an important clinical clue prompting further investigation, such as a venous ultrasound.

Option B: Pulmonary embolism is a complication of DVT, not the condition directly indicated by Homans' sign. The sign is localized to the leg, whereas a PE involves the lungs.
Option C: Pneumothorax is a respiratory condition involving a collapsed lung. Its signs and symptoms (e.g., dyspnea, absent breath sounds) are unrelated to the lower extremities.
Option D: A stroke is a neurological event affecting the brain. Its symptoms (e.g., hemiparesis, aphasia, facial droop) are central in origin and not related to calf pain on physical examination.

Visual 1: Diagram: A diagram illustrating the correct technique for performing the Homans' sign maneuver on a patient's leg.
Visual 2: Illustration: An anatomical illustration showing a deep vein thrombus within a calf vein, highlighting the location of potential pain.
Visual 3: Flowchart: A diagnostic algorithm for suspected DVT, showing where Homans' sign fits in alongside other assessments like the Wells score and D-dimer testing.

Clinical Relevance

Nursing practice connection: Knowing Interpretation of Homans' sign in the context of vascular disorders helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
While Homans' sign is taught, modern nursing practice emphasizes its unreliability. Nurses should rely on more definitive assessments like the Wells score for DVT probability and prepare the patient for diagnostic imaging (e.g., venous Doppler ultrasound).
A critical nursing responsibility is patient safety. If DVT is suspected, the nurse must instruct the patient to remain on bed rest and avoid massaging the leg to prevent dislodging the clot.
What if? If a patient with a positive Homans' sign also reports sudden onset of sharp chest pain and becomes tachycardic and short of breath, the nurse's priority shifts immediately. This indicates a possible pulmonary embolism, a medical emergency requiring rapid response and intervention.

How to Approach the Question

First, identify the key term in the question: 'Homans' sign'.
Recall the definition and clinical significance of this specific physical assessment finding.
Systematically evaluate each option to see which condition is directly associated with the sign.
Option A (DVT) is the classic association with calf pain on dorsiflexion.
Option B (PE) is a complication of DVT, but the sign itself is for the DVT in the leg.
Options C (Pneumothorax) and D (Stroke) are unrelated pathologies affecting the lungs and brain, respectively.

Concept Tested & Keywords

Concept Tested: Interpretation of Homans' sign in the context of vascular disorders.
Stem keywords: Homans sign, positive
Lead-in keywords: interprets as
Negative lead-in flag: false

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