Editing Anatomy and Physiology – RN Practice Questions (section)

==Question 12==
A patient returns to the unit after a total thyroidectomy. Which assessment finding requires the '''most immediate''' nursing action?
# A hoarse, weak voice.
# Tingling and numbness around the mouth and in the fingertips.
# Serosanguineous drainage on the anterior neck dressing.
# Reported difficulty swallowing solid food.

'''Answer:''' 2 (B). Tingling and numbness around the mouth and in the fingertips.

''Rationale:'' The parathyroid glands lie on the posterior surface of the thyroid and may be injured or inadvertently removed during thyroidectomy. Loss of parathyroid hormone causes serum calcium to fall, and because calcium stabilizes nerve membranes, hypocalcemia produces increased neuromuscular excitability. Perioral and digital paresthesias are the earliest manifestation and can progress to carpopedal spasm, tetany, and laryngospasm, which is an airway emergency. The nurse should check serum calcium, assess for Chvostek and Trousseau signs, notify the provider, and confirm that calcium gluconate is available. Option 1 is common after thyroidectomy from transient laryngeal nerve irritation and warrants monitoring. Option 3 is expected in a small amount, though the nurse should check behind the neck for pooling. Option 4 is common from postoperative edema.