A nurse on physical examination of patient finds postural hypotension, tachycardia, nausea and vomiting, postural dizziness. Which electrolyte imbalance can be diagnosed?

1. A

   Hypokalemia

2. B

   Hypocalcemia

3. C

   Hyponatremia

4. D

   Hypernatremia

Appeared in: NVS- 2025

Explanation

• The patient's symptoms are characteristic of hyponatremia, specifically hypovolemic hyponatremia, where there is a loss of both water and sodium.
• Postural hypotension, tachycardia, and postural dizziness are direct results of decreased circulating blood volume (hypovolemia).
• Nausea and vomiting are common early signs of hyponatremia and can also be the cause of fluid and sodium loss.
• The combination of these specific cardiovascular and gastrointestinal signs makes hyponatremia the most likely diagnosis among the choices.

Why Other Options Were Wrong

• Option A: While hypokalemia can cause nausea, vomiting, and hypotension, its hallmark signs are related to muscle function, such as significant muscle weakness, leg cramps, and cardiac dysrhythmias (e.g., flattened T-waves on an ECG).
• Option B: Hypocalcemia primarily presents with signs of neuromuscular excitability.
• Option D: Hypernatremia is a state of high sodium, usually associated with dehydration. Its primary symptom is intense thirst. Other signs include dry, sticky mucous membranes and neurological changes like restlessness or lethargy, not typically postural hypotension.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Recognition of clinical manifestations for common electrolyte imbalances to guide bedside assessment, documentation, and the next nursing action.
• Recognizing the signs of hyponatremia is critical for nurses as it can lead to severe complications like seizures, coma, and death if not treated promptly.
• A key nursing responsibility is implementing safety measures, especially fall precautions, for patients with postural hypotension and dizziness to prevent injury.
• What if? If the patient's primary complaints were muscle cramps, numbness and tingling in the fingers, and a positive Trousseau's sign (carpal spasm with blood pressure cuff inflation), the most likely imbalance would be Hypocalcemia.

How to Approach the Question

• First, identify all the clinical signs presented in the question: postural hypotension, tachycardia, nausea, vomiting, and postural dizziness.
• Group the symptoms. Notice that postural hypotension, tachycardia, and dizziness are cardiovascular signs related to fluid volume.
• Recognize that nausea and vomiting are gastrointestinal symptoms that can both cause and result from an electrolyte imbalance.
• Evaluate each option. Consider which electrolyte imbalance is most commonly associated with this specific cluster of fluid volume deficit and GI symptoms.
• Recall that hyponatremia (especially hypovolemic) classically presents with hypotension and tachycardia due to fluid loss, along with GI disturbances.
• Eliminate the other options by comparing their hallmark signs (e.g., muscle weakness for hypokalemia, tetany for hypocalcemia, thirst for hypernatremia) with the patient's presentation.

Concept Tested & Keywords

• Concept Tested: Recognition of clinical manifestations for common electrolyte imbalances.
• Stem keywords: postural hypotension, tachycardia, nausea and vomiting, postural dizziness
• Lead-in keywords: Which electrolyte imbalance
• Clinical cues: The combination of cardiovascular signs (postural hypotension, tachycardia) and gastrointestinal symptoms (nausea, vomiting) points towards a specific type of electrolyte imbalance.

Question ID

Q9FLRNmde6elXgBB1jnCbK

Copy ID

Reference Book

E6 Nursing Fundamentals Taylor p. 779-781

E6 Pharmacology Nursing Lilley 11e Part 2 p. 173-175

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 1 p. 149-151