NCLEX Question of the Day – Wednesday, March 04, 2026

Today’s question targets rapid recognition and prioritization in a post-op emergency. On a real shift, seconds matter when airway compromise develops. You need to read subtle cues, apply ABCs, and choose the single best first action that protects life while you mobilize help.

Clinical Scenario

A 42-year-old woman is 6 hours post–total thyroidectomy on a surgical unit. She had Graves disease and no prior airway issues. She reports tingling around her mouth and in both hands. Her voice, which was hoarse earlier, now sounds weaker. You hear faint inspiratory stridor at the bedside. Vitals: BP 132/78, HR 110, RR 24, SpO2 96% on 2 L nasal cannula. The lab just posted a serum calcium of 7.0 mg/dL. The anterior neck dressing is dry with no visible swelling.

The Question

Which action is the nurse’s priority?

Answer Choices

1. A. Administer the prescribed IV calcium gluconate via a large-bore peripheral line
2. B. Coach the patient to perform coughing and deep-breathing exercises
3. C. Loosen the neck dressing and raise the head of the bed to high Fowler’s
4. D. Call the Rapid Response Team and prepare for emergency airway management

Correct Answer

D. Call the Rapid Response Team and prepare for emergency airway management

Detailed Rationale

This is an airway-first situation. The combination of recent thyroid surgery, new tingling (hypocalcemia), worsening hoarseness, and stridor points to laryngeal irritability and possible laryngospasm. Hypocalcemia after thyroidectomy occurs when parathyroid blood supply is disrupted. Low calcium increases neuromuscular excitability, which can clamp the airway without warning.

ABCs guide your priority. Stridor is an upper airway alarm sign. Even with a normal pulse oximetry at rest, the airway can close suddenly. The safest first move is to summon expert help and get airway equipment to the bedside.

Immediate nursing actions after calling Rapid Response:

• Maintain airway: position upright, apply high-flow oxygen, have suction ready, and bring the bag-valve-mask.
• Prepare for definitive airway: ensure the tracheostomy set is at the bedside (standard after thyroid surgery). Alert anesthesia and the surgeon.
• Anticipate IV calcium: hypocalcemic laryngospasm improves with IV calcium. Start a patent IV and gather calcium gluconate as soon as help is on the way.
• Monitor closely: place on continuous pulse oximetry and cardiac monitoring. Hypocalcemia can prolong QT and trigger dysrhythmias.
• Reassess the neck: look for swelling, firmness, or tracheal deviation suggesting a hematoma that could also compress the airway.

Why this order matters: securing the airway prevents respiratory arrest. Calcium is important but acts after infusion begins; it does not replace the need to control the airway now. You can do both, but the first step is to call for help and prepare the airway.

Why the Other Options Are Wrong

• A. Administer the prescribed IV calcium gluconate via a large-bore peripheral line: Correct therapy for hypocalcemia, but not the first priority with active stridor. Starting an infusion takes time and can delay airway control. Give calcium once airway resources are en route and the patient is positioned and oxygenated.
• B. Coach the patient to perform coughing and deep-breathing exercises: Useful for routine post-op pulmonary hygiene, but it does not treat laryngospasm or upper airway obstruction. Coaching could worsen fatigue and anxiety without improving the cause.
• C. Loosen the neck dressing and raise the head of the bed to high Fowler’s: Elevating the head helps, but loosening the dressing is not indicated without evidence of a tight dressing or neck hematoma. There is no swelling, firmness, or bleeding here. Unnecessary manipulation may disrupt the wound. Even if indicated, this is supportive, not definitive.

Key Takeaways

• After thyroidectomy, watch for hypocalcemia (perioral tingling, paresthesias, cramps, positive Chvostek/Trousseau) and airway signs (hoarseness, stridor).
• Stridor equals airway emergency. Follow ABCs: call for help, oxygen, suction, bag-valve-mask, prepare for intubation or tracheostomy.
• Hypocalcemic laryngospasm improves with IV calcium, but airway control comes first.
• Have a tracheostomy set, suction, and calcium available at the bedside for fresh thyroidectomy patients.
• Reassess the neck for hematoma if breathing changes; swelling, firmness, or tracheal shift require immediate escalation.

On-shift mini-checklist for fresh thyroidectomy (first 24 hours):

• Bedside setup: oxygen, suction, bag-valve-mask, trach set, patent IV, calcium available.
• Assess q2–4h: voice quality, swallowing, neck swelling, respiratory sounds, neuromuscular symptoms.
• Labs and monitor: trending calcium, magnesium; place on cardiac monitor if symptomatic.
• If stridor/hoarseness worsens: call Rapid Response, position upright, high-flow O2, prepare airway, then give IV calcium as ordered.

Quick Practice Extension

• What ECG changes would you watch for in acute hypocalcemia, and how would that affect your monitoring plan?
• If the neck becomes rapidly swollen and firm with tracheal deviation, which immediate steps should you take before the surgeon arrives?

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