A patient has hyperkalemia. The nurse knows that this condition can cause major life-threatening complications. Which of the following signs indicates a complication of hyperkalemia?

Appeared in: NORCET 7 Prelims -2024

Explanation

Hyperkalemia, an elevated serum potassium level, directly interferes with the heart's electrical repolarization process.
The earliest and most characteristic sign of this on an ECG is the development of tall, peaked, or 'tented' T-waves.
This electrical instability is a major complication because it can rapidly progress to life-threatening cardiac dysrhythmias, such as ventricular fibrillation or asystole.

Option B: A flat T-wave is a classic sign of hypokalemia (low potassium), not hyperkalemia.
Option C: While a prolonged PR interval is a sign of hyperkalemia, it is a later finding that occurs after the initial T-wave changes. The tall, tented T-wave is the more immediate and classic indicator.
Option D: Shallow breathing due to respiratory muscle weakness is a sign of severe hypokalemia. Increased heart rate (tachycardia) is also not typical for hyperkalemia; bradycardia is more common as the condition worsens.

Clinical Relevance

Nursing practice connection: Use the key finding related to ECG Changes in Hyperkalemia to guide bedside assessment, documentation, and the next nursing action.
Recognizing the ECG changes of hyperkalemia is a critical nursing skill, as it is a medical emergency requiring immediate intervention to prevent cardiac arrest.
For any patient with known or suspected hyperkalemia (e.g., patients with renal failure, on certain medications like ACE inhibitors), continuous cardiac monitoring is a priority nursing action.
What if? If the patient's potassium level was critically low (hypokalemia), the nurse would anticipate ECG changes like flattened T-waves, prominent U-waves, and ST depression, and would prepare to administer potassium supplements, not interventions to lower potassium.

How to Approach the Question

Identify the core concept from the stem: The question asks for a sign indicating a complication of 'hyperkalemia'.
Recall the primary organ system affected by potassium imbalances: the heart. This focuses your attention on cardiovascular signs.
Access your knowledge about the specific ECG changes associated with high potassium. The classic, initial sign involves the T-wave.
Evaluate the options. 'Tall, tented T wave' is the textbook ECG finding for hyperkalemia.
Systematically eliminate the other options by identifying why they are incorrect. Associate 'flat T wave' and 'shallow breathing' with hypokalemia, and recognize 'prolonged PR interval' as a later sign of hyperkalemia.

Concept Tested & Keywords

QiGhJwPUkWSGLuA5eMfVHF

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 542-544

E6 Medicine Harrison 22e Part 1 pp. 1915-1917, 400-402

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