how do you know when to report expected or unexpected sign on test

[direw0lf, BSN]

I'm taking practice nclex exams and having a lot of trouble with expected vs. unexpected.

The stem of the question says what is wrong (ie: hyperthyroidism, increased ICP, etc) Then it says "what does the nurse report to the health care provider?"

Well in Kaplan it seems like they want you to report the expected findings/assessment even though it states it in the stem. But on Uworld it wants you to report the unexpected findings more, it seems.

For example, hyperthyroidism I know the s/s! But I picked "slow sluggish pulse" as the answer because that would be unexpected over the correct answer which was "anxiety" to report to the HCP.

And in increased ICP in an infant it was "high pitch cry" which I knew, but I picked "sudden limb paralysis" because that was unexpected right?

How do you know which to pick? Any tips welcome please! TIA!

[NICU Guy, BSN, RN]

Unexpected signs are things that indicate the patient's condition has gotten worse and needs immediate attention. For example, you are caring for a patient that had hip replacement surgery. Patient complains of hip pain and being uncomfortable. Those are expected signs of someone that had hip surgery. Two hours later, you can't feel a pulse in the foot, leg is dusky, and the patient is complaining of severe pain in the leg and foot. Those are unexpected signs.

[203bravo, MSN, APRN]

It's also difficult to offer any advice without knowing the context of the question.. Looking at the infant as an example

If the question read: you are caring for an infant that was admitted for XyZ injury or illness and you suspect has developed increased ICP, which s/sx would you report -- then high pitch crying would be most correct since it is a classic sign for increased ICP and not an expected sign for their current diagnosis.

However if you were caring for an infant with a confirmed diagnosis of increased ICP then you may not report the high pitch crying since it is an expected sign associated with the diagnosis but a sudden limb paralysis would be most appropriate since it could indicate that either a new problem exists or the ICP is not responding to treatment and is getting worse.

On a side note --- Anytime any patient has sudden limb paralysis, you can bet I'm going to report it immediately.. :)

[KelRN215, BSN, RN]

A high pitched cry is a sign of increasing ICP in an infant. Sudden limb paralysis would need to be reported, as well, but it may or may not be related at all to the disease process the question is asking about. If, for example, the baby has increased ICP because of a brain tumor or a vascular malformation, sudden unilateral limb paralysis would be cause for concern of a stroke. But high pitched cry should always be reported in these infants, just like headache with vomiting or double vision and lethargy would be the initial signs of increased ICP you'd report in older kids.