A nurse is performing a physical assessment on a patient with chronic liver disease. The nurse observes involuntary rhythmic, non-synchronous flapping movements of the hands when the patient extends the wrists with arms outstretched and fingers spread. What is this neurological sign called?

Answer and explanation

Correct answer: D. Asterixis

  1. Step 1: Asterixis ('flapping tremor') is a negative myoclonus characterized by brief, involuntary lapses of sustained wrist extension with rapid recovery.
  2. Step 2: It is a classic sign of metabolic encephalopathy, most commonly associated with decompensated hepatic failure and hyperammonemia, as well as severe uremia and hypercapnia.
Answer
Asterixis (liver flap).
Why not the others: 'Chorea' describes continuous, irregular, rapid dance-like involuntary movements (e.g., Huntington disease); 'Myoclonus' refers to sudden positive muscle jerks; 'Ataxia' is lack of voluntary coordination of muscle movements.

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