護理師正在評估一位 12 小時前接受甲狀腺切除術的病人。哪項發現最能暗示病人正在發生低血鈣？
A nurse is assessing a client who had a thyroidectomy 12 hours ago. Which finding would most suggest the client is developing hypocalcemia?
- AIncreased urinary output尿量增加
- BNegative Chvostek’s signChvostek 徵象陰性
- CWeight gain and bradycardia體重增加和心動過緩
- DPositive Trousseau’s sign✓ 正解Trousseau 徵象陽性
甲狀腺切除術中，副甲狀腺可能會被意外移除或受損，導致副甲狀腺素下降，進而引發急性低血鈣。低血鈣會增加神經肌肉的興奮性。Trousseau's sign（B，充氣血壓計袖帶時誘發手部痙攣）是低血鈣的高特異性徵象。Chvostek's sign 陽性（叩擊面神經引起臉部抽動）也是徵象，但選項 B 說是陰性，故錯誤。體重增加與心搏過緩（C）較偏向甲狀腺功能低下。及時發現這些物理徵象有助於早期補充鈣劑，預防喉頭痙攣或抽搐等致命風險。這屬於術後併發症監測的重要環節。
During thyroidectomy, the parathyroid glands may be inadvertently removed or damaged, lowering parathyroid hormone and producing acute hypocalcemia, which increases neuromuscular excitability. A positive Trousseau's sign (carpal spasm with BP cuff inflation) is highly specific for hypocalcemia. A positive Chvostek's sign (facial twitch on tapping the facial nerve) is also indicative, but option B says 'negative,' which is incorrect. Weight gain and bradycardia (C) suggest hypothyroidism. Timely identification of these physical signs allows prompt calcium supplementation and prevents lethal complications such as laryngospasm or tetany. This is a key post-op complication to monitor.
在美國 NCLEX 邏輯中，甲狀腺術後的「鈣離子監測」是與「呼吸道安全」並列的兩大考點。台灣臨床實務中，護理師同樣會監測四肢麻木感，但美國 RN 必須熟記這些專有名詞（Trousseau/Chvostek）並能主動執行物理評估。