NCLEX Question of the Day – Tuesday, March 03, 2026

Today’s question targets rapid prioritization after surgery: spotting airway compromise and acting in the right order. This matters because small delays after neck surgery can turn a fixable problem into a respiratory arrest. Nurses are often the first to recognize subtle changes and must move fast, clearly, and safely.

Clinical Scenario

A 52-year-old client is 8 hours post–total thyroidectomy on a surgical unit. History includes hypertension and mild asthma. The client reports tingling around the mouth and in both fingers. The voice sounds hoarse. Respiratory rate is 24/min with use of accessory muscles. Stridor is audible at the bedside. Pulse is 112/min, blood pressure 142/86 mm Hg, SpO2 89% on room air. The neck dressing is dry; the JP drain has 20 mL serosanguineous output for the shift.

The Question

Which action should the nurse take first?

Answer Choices

1. Notify the surgeon and prepare to administer IV calcium gluconate.
2. Encourage deep breathing and coughing every hour.
3. Assess the surgical drain for excess bleeding.
4. Apply high-flow oxygen via nonrebreather mask and activate the rapid response team.

Correct Answer

D. Apply high-flow oxygen via nonrebreather mask and activate the rapid response team.

Detailed Rationale

This client shows signs of acute airway compromise after thyroidectomy: stridor, hypoxemia (SpO2 89%), tachypnea, and accessory muscle use. Paresthesias and hoarseness suggest postoperative hypocalcemia from unintended parathyroid injury, which can trigger laryngospasm. Laryngospasm plus neck surgery makes the airway high risk.

Airway is the immediate priority (ABCs). The safest first step is to deliver the highest fraction of inspired oxygen quickly and to get help at the bedside. A nonrebreather mask supplies high-flow oxygen while you escalate care. Activating the rapid response team brings skilled help for potential airway obstruction and imminent respiratory failure.

After oxygen and rapid response activation, the nurse should:

• Position the client upright to ease breathing.
• Call for emergency equipment: suction, bag-valve mask, and the tracheostomy/emergency airway kit that should be at the bedside after thyroid surgery.
• Prepare to assist with airway maneuvers and potential reintubation if ordered.
• Notify the surgeon and anticipate IV calcium administration to treat hypocalcemia and reduce laryngospasm risk.
• Place the client on continuous pulse oximetry and cardiac monitoring (calcium infusions can affect cardiac rhythm).
• Assess for other contributors to airway compromise, such as neck swelling or expanding hematoma, while maintaining airway support.

Why this order? Oxygen and escalation protect life while definitive treatment (IV calcium, possible reintubation) is arranged. Delaying oxygen and help can allow complete airway obstruction, which is harder to reverse in fresh neck surgery.

Why the Other Options Are Wrong

• A. Notify the surgeon and prepare to administer IV calcium gluconate: Correct therapy, wrong sequence. Calcium can reverse neuromuscular irritability from hypocalcemia, but it takes time to obtain and give safely. Airway support and rapid response activation must come first to prevent arrest.
• B. Encourage deep breathing and coughing every hour: This is a routine postoperative intervention. It does not address acute stridor or hypoxemia. Coughing could worsen airway spasm and distress right now.
• C. Assess the surgical drain for excess bleeding: Important assessment, but not the priority when stridor and low SpO2 are present. A hematoma could be contributing, but managing the airway and oxygenation comes first; you can evaluate the neck once the client is stabilized and help is on the way.

Key Takeaways

• After thyroidectomy, watch for hypocalcemia (tingling, cramps, positive Chvostek/Trousseau, hoarseness) and airway red flags (stridor, low SpO2, increased work of breathing).
• ABCs guide priorities: treat airway and oxygenation before definitive therapies.
• Stridor = emergency. Apply high-flow oxygen and activate rapid response immediately.
• Expect orders for IV calcium gluconate, continuous monitoring, and possible airway intervention.
• Keep emergency airway equipment, suction, and oxygen at the bedside for all fresh neck surgeries.

• On-shift mini-checklist (post-thyroidectomy):
• Ensure bedside setup: oxygen, suction, bag-valve mask, trach/emergency airway kit.
• Assess voice, swallowing, neck swelling, drain output, and respiratory status each check.
• Monitor calcium, magnesium, and phosphorus when labs return.
• Educate patient to report tingling, muscle cramps, or throat tightness immediately.
• At first sign of stridor or hypoxemia: high-flow O2, sit up, call rapid response, get equipment, notify surgeon, prepare calcium.

Quick Practice Extension

• You suspect hypocalcemia after thyroidectomy, but there is no stridor. Which two priority labs and one ECG change would you anticipate, and why?
• A client post-thyroidectomy suddenly becomes anxious with a muffled voice and a tense, bulging neck incision. What are your first three actions in order?

G S Sachin

I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.

Mail- Sachin@pharmacyfreak.com