HPSSSB Staff Nurse - 2016
Medical & Surgical Nursing
Medium
A patient had an elective and prolonged surgery, which electrolyte should be monitored most closely?
Appeared in: HPSSSB Staff Nurse - 2016
Explanation
- Prolonged surgery triggers a significant stress response, leading to the release of aldosterone, which causes the kidneys to excrete potassium, increasing the risk of hypokalemia.
- Simultaneously, extensive tissue damage from the surgery can cause cell lysis, releasing intracellular potassium into the bloodstream and creating a risk for hyperkalemia.
- Potassium has a very narrow normal serum range (3.5-5.0 mEq/L), and even minor deviations can lead to life-threatening cardiac dysrhythmias.
- This dual risk of both critically low and critically high potassium levels, combined with its direct and immediate impact on heart function, makes it the most important electrolyte to monitor closely after major surgery.
Why Other Options Were Wrong
- Option B: While sodium is crucial for fluid balance and neurologic function, the body's stress response to surgery causes sodium retention. Therefore, a sudden drop is less likely than a potassium imbalance. Its normal range is also wider, making fluctuations less immediately critical than potassium.
- Option C: Chloride levels typically move in conjunction with sodium levels. Its balance is usually managed as a part of managing sodium and acid-base status, rather than being the primary electrolyte of concern.
- Option D: Calcium is not routinely the most critical electrolyte to monitor after general prolonged surgery. Its levels are more stable unless specific risk factors are present.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to Post-operative electrolyte management to guide bedside assessment, documentation, and the next nursing action.
- Nurses must continuously monitor the ECG for signs of potassium imbalance, such as peaked T-waves (hyperkalemia) or flattened T-waves/U-waves (hypokalemia), and report them immediately.
- A critical patient safety rule is to confirm adequate urine output (at least 30 mL/hr) before administering any IV potassium. Giving potassium to a patient with impaired kidney function can lead to lethal hyperkalemia.
- Never administer potassium as an IV push. It must always be diluted and infused slowly via a pump to prevent cardiac arrest.
How to Approach the Question
- Identify the key clinical event in the question stem: 'prolonged surgery'.
- Recall the body's physiological stress response to major trauma or surgery. This involves the release of hormones like aldosterone.
- Analyze the effect of this hormonal response on different electrolytes. Aldosterone specifically causes sodium/water retention and potassium excretion.
- Consider other potential effects of surgery, such as tissue damage, which releases intracellular potassium.
- Evaluate the clinical significance of each potential electrolyte imbalance. Prioritize based on the narrowness of the normal range and the severity/immediacy of consequences.
- Conclude that potassium's narrow therapeutic window and its direct, potent effect on cardiac muscle make it the highest priority for monitoring to prevent life-threatening arrhythmias.
Concept Tested & Keywords
- Concept Tested: Post-operative electrolyte management
- Stem keywords: prolonged surgery, electrolyte, monitored
- Lead-in keywords: most closely
- Clinical cues: The term 'prolonged surgery' implies a significant physiological stress response and potential for major fluid shifts and tissue trauma.
- Negative lead-in flag: false
Question ID
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Reference Book
E6 Nursing Fundamentals Potter Perry 12e Part 6 p. 168-170
E6 Pharmacology Nursing Lilley 11e Part 2 p. 164-166
Practise the full HPSSSB Staff Nurse - 2016
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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