AIIMS Delhi NO- 2019
Medical & Surgical Nursing
Easy
ECG of the patient is showing ST depression, Prominent U wave and inverted T wave. Which of the electrolyte imbalance present?
Appeared in: AIIMS Delhi NO- 2019
Explanation
- The combination of ST-segment depression, a prominent U wave, and T-wave inversion on an ECG are hallmark signs of hypokalemia.
- The normal serum potassium (K+) level is 3.5 to 5.0 mEq/L.
- The patient's potassium level of 2.2 mEq/L is significantly below the normal range, confirming severe hypokalemia, which is consistent with the ECG findings.
Why Other Options Were Wrong
- Option B: The normal serum calcium level is 8.5-10.5 mg/dL. A level of 8.2 mg/dL indicates mild hypocalcemia. The characteristic ECG change for hypocalcemia is a prolonged QT interval, not the findings described in the question.
- Option C: The normal serum magnesium level is approximately 1.7 to 2.2 mg/dL. The patient's level of 1.8 mg/dL is within the normal range and would not be the cause of these ECG changes.
- Option D: The normal serum sodium level is 135-145 mEq/L. A level of 133 mEq/L indicates mild hyponatremia. Sodium imbalances do not typically cause specific, characteristic ECG changes like those seen with potassium abnormalities.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to Interpretation of ECG findings in the context of electrolyte imbalances to guide bedside assessment, documentation, and the next nursing action.
- Nurses must be able to recognize ECG changes associated with electrolyte imbalances, as they can signal life-threatening conditions. Severe hypokalemia (K+ less than 2.5 mEq/L) can lead to dangerous cardiac arrhythmias, such as ventricular tachycardia or fibrillation, and requires immediate intervention.
- Common causes of hypokalemia include diuretic use (especially loop and thiazide diuretics), vomiting, diarrhea, and inadequate dietary intake. It is a critical nursing responsibility to monitor labs for at-risk patients.
- What if? If the ECG had shown tall, peaked T waves and a widened QRS complex, the correct answer would be hyperkalemia (high potassium). This is equally dangerous and requires different, urgent interventions like administering insulin and glucose, or calcium gluconate.
How to Approach the Question
- First, identify the key clinical data provided in the question stem. Here, the crucial information is the specific triad of ECG findings: ST depression, prominent U wave, and inverted T wave.
- Next, access your knowledge base on how different electrolyte imbalances affect the heart's electrical activity and manifest on an ECG. Try to recall the classic patterns for potassium, calcium, and magnesium.
- Systematically evaluate each option. For each electrolyte, compare the given lab value to its normal physiological range to determine if it's high, low, or normal.
- Correlate the lab finding with the ECG pattern. The triad of ST depression, U waves, and T-wave changes is a textbook presentation of hypokalemia.
- Confirm your choice. The lab value of Potassium 2.2 mEq/L is significantly low (normal is 3.5-5.0 mEq/L), which perfectly aligns with the ECG findings of hypokalemia.
- Finally, quickly rule out the other options. Note that the magnesium level is normal, and the changes for hypocalcemia (prolonged QT) and hyponatremia (no specific changes) do not match the question's description.
Concept Tested & Keywords
- Concept Tested: Interpretation of ECG findings in the context of electrolyte imbalances.
- Stem keywords: ECG, ST depression, Prominent U wave, inverted T wave, electrolyte imbalance
- Lead-in keywords: Which of
- Clinical cues: The combination of ST depression, prominent U wave, and inverted T wave is a classic triad for a specific electrolyte disorder.
Question ID
QdYS-n3CUBjVnMc5r7zzqB
Reference Book
E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 53-55
E6 Pharmacology Nursing Lilley 11e Part 2 p. 164-166
Practise the full AIIMS Delhi NO- 2019
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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