A nurse working in ICU and caring for a renal failure client. She noticed on cardiac monitor that the ECG wave is a tall peaked wave, shortened QT interval, and wide QRS complex. She knows what the doctor will order for the correction of this condition?

1. A

   lidocaine injection

2. B

   25% dextrose with insulin added

3. C

   Inj. Potassium chloride

4. D

   Defibrillator

Appeared in: JIPMER Pondicherry NO - 2022

Explanation

• The patient's ECG findings—tall peaked T-waves and a wide QRS complex—are hallmark signs of hyperkalemia, a common and life-threatening complication of renal failure.
• The definitive emergency treatment is to shift potassium from the extracellular fluid (blood) into the intracellular space.
• Administering insulin activates the Na-K-ATPase pump, which drives potassium into the cells, rapidly lowering serum levels.
• Dextrose (glucose) is given simultaneously to counteract the effect of insulin and prevent iatrogenic hypoglycemia.

Why Other Options Were Wrong

• Option A: Lidocaine is an antiarrhythmic drug that treats ventricular arrhythmias but does not correct the underlying cause, which is the electrolyte imbalance (hyperkalemia).
• Option C: Administering potassium chloride is absolutely contraindicated. It would further increase the already dangerously high serum potassium level, likely leading to fatal cardiac arrest.
• Option D: A defibrillator is used for electrical therapy in cases of cardiac arrest due to pulseless ventricular tachycardia or ventricular fibrillation. It is not a primary treatment for the metabolic abnormality causing the ECG changes.

Related Visual

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Emergency management of hyperkalemia in a patient with renal failure in acute care settings.
• Recognizing the ECG signs of hyperkalemia is a critical skill for any nurse, especially in critical care and nephrology settings, as it is a medical emergency.
• The nurse's role includes prompt identification, notifying the physician, and preparing for the immediate administration of emergency medications like insulin, dextrose, and calcium gluconate.
• Patient safety is paramount. The nurse must ensure that potassium is never administered to a hyperkalemic patient and that a patient receiving an insulin infusion is closely monitored for hypoglycemia.

How to Approach the Question

• First, identify the key elements in the clinical scenario: the patient has renal failure, and the monitor shows specific ECG changes.
• Correlate the patient's underlying condition (renal failure) with the clinical findings. Renal failure is a major risk factor for hyperkalemia.
• Recognize the ECG pattern (tall peaked T-waves, wide QRS) as the classic presentation of hyperkalemia.
• The question asks for the 'correction' of the condition. This means you are looking for a treatment that lowers the serum potassium level.
• Evaluate each option's mechanism of action in the context of hyperkalemia.
• Eliminate options that are contraindicated (Potassium chloride) or treat symptoms without correcting the cause (Lidocaine, Defibrillator).

Concept Tested & Keywords

• Concept Tested: Emergency management of hyperkalemia in a patient with renal failure.
• Stem keywords: renal failure, cardiac monitor, tall peaked T wave, wide QRS complex, shortened QT interval
• Lead-in keywords: what the doctor will order, correction of this condition
• Clinical cues: The combination of renal failure (a common cause of potassium retention) and classic ECG changes strongly points to hyperkalemia.

Question ID

QcuA5oEcDGGC732W96oam3

Copy ID

Reference Book

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 1048-1050

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 3 p. 48-50