A nurse is reviewing the laboratory values of a client who has a positive Chvosteks sign

What is Chvostek’s Sign?

A Chvostek’s sign is an abnormal reaction to the stimulation of the facial nerve. Tapping the facial nerve leads to twitching, typically in the nose or mouth. When a patient demonstrates a Chvostek’s sign, it is a sign that they could have hypocalcemia (low calcium).

To learn more about the signs and symptoms of hypocalcemia, check out our Medical-Surgical flashcards for nursing students.

What is hypocalcemia?

Hypocalcemia is a condition of lower-than-average levels of calcium in the blood. The normal adult value for calcium is 4.5 - 5.5 mEq/L, so amounts lower than 4.5 mEq/L indicate hypocalcemia. Hypocalcemia can be caused by a vitamin D deficiency, because vitamin D allows the body to absorb calcium. It can also be caused by chronic renal failure, magnesium deficiency, alcoholism and more. The treatment of hypocalcemia is based on correcting the underlying cause. If the patient is found to have a possible dysfunction of the endocrine system, such as hypoparathyroidism, they may be referred to an endocrinologist. If the hypocalcemia is due to medications or treatments, these may be altered or removed, if possible.

Hypoparathyroidism is covered in our Medical-Surgical flashcards for nursing students, the lab values for calcium levels and many more can be found in our lab values flashcards!

How do you check for Chvostek’s sign?

If you suspect that your patient is suffering from hypoparathyroidism or hypocalcemia, you can check your patient for the Chovostek's sign by tapping their cheek over the area of the facial nerve. This facial nerve can be found at a point on the face just anterior to the ear and just below the cheekbones.

What is a positive Chvostek’s sign?

A patient will exhibit a positive Chvostek’s sign when twitching of the facial muscles occur in response to tapping over the area of the facial nerve.

What is a negative Chvostek’s sign?

A negative Chvostek’s sign is when the facial nerves are stimulated and no contractions of the facial muscle occur.

Trousseau’s sign vs Chvostek’s sign

Chvostek’s sign is the twitching of facial muscles in response to tapping over the area of the facial nerve, while Trousseau’s sign is a carpopedal spasm (frequent and involuntary muscle contractions in the hands and feet) that results from ischemia (inadequate blood supply to the heart muscles), which is induced by pressure applied to the upper arm from an inflated blood pressure cuff.

Chvostek’s sign is not a perfect measure for hypocalcemia, because it is absent in about 33% of patients with hypocalcemia, and is present in about 10% of people with normal calcium levels! Trousseau’s sign, however, is a better measurement and is present in 94% of patients with hypocalcemia and in only 1% of people with normal calcium levels.

To learn more about Trousseau’s sign, check out our article on thyroidectomy.

Detailed Answer Key

ATI Complex Endocrine Practice

1.A nurse is caring for a client who is 1 day postoperative following a subtotal thyroidectomy. The client reports a

tingling sensation in the hands, the soles of the feet, and around the lips. For which of the following findings should

the nurse assess the client?

A. Chvostek's sign

Rationale:The nurse should suspect that the client has hypocalcemia, a possible complication following

subtotal thyroidectomy. Manifestations of hypocalcemia include numbness and tingling in the

hands, the soles of the feet, and around the lips, typically appearing between 24 and 48 hr after

surgery. To elicit Chvostek's sign, the nurse should tap the client's face at a point just below and

in front of the ear. A positive response would be twitching of the ipsilateral (same side only)

facial muscles, suggesting neuromuscular excitability due to hypocalcemia.

B. Babinski's sign

Rationale:Babinski's sign is a diagnostic test for brain damage or upper motor neuron damage. It is

positive if the toes flare up when the nurse strokes the plantar aspect of the foot.

C. Brudzinski's sign

Rationale:Brudzinski's sign is an indication of meningeal irritation, such as in clients who have meningitis.

With the client supine, the nurse should place one hand behind his head and places her other

hand on his chest. The nurse then raises the client's head with her hand behind his head, while

the hand on his chest restrains him and prevents him from rising. Flexion of the client's lower

extremities constitutes a positive sign.

D. Kernig's sign

Rationale:Kernig's sign is an indication of meningeal irritation, such as in clients who have meningitis. The

nurse performs the maneuver with the client supine with his hips and knees in flexion. The

inability to extend the client's knees fully without causing pain constitutes a positive test.

2.A nurse is caring for an adolescent client who has a long history of diabetes mellitus and is being admitted to the

emergency department confused, flushed, and with an acetone odor on the breath. Diabetic ketoacidosis is

suspected. The nurse should anticipate using which of the following types of insulin to treat this client?

A. NPH insulin

Rationale:Isophane NPH insulin is intermediate-acting. It has an onset of action of 1 to 3 hr and is not

appropriate for emergency treatment of ketoacidosis.

B. Insulin glargine

Rationale:Insulin glargine is a long-acting insulin, with an onset of 2 to 4 hr. It is not appropriate for

emergency treatment of ketoacidosis.

C. Insulin detemir

Rationale:Insulin detemir is an intermediate-acting insulin. It has an onset of action of 1 hr and is not

appropriate for emergency treatment of ketoacidosis.

D. Regular insulin

Rationale:

Created on:08/13/2018Page 1