SCTIMST Staff Nurse - 2015 (Set-A)
Medical & Surgical Nursing
Easy
In the ECG recording of a client, the nurse observes tall peaked T waves, flat P waves, widened QRS complex, and prolonged PR interval. The nurse identifies?
Appeared in: SCTIMST Staff Nurse - 2015 (Set-A)
Explanation
- The constellation of ECG findings described in the question is the hallmark presentation of hyperkalemia.
- Tall, peaked T-waves are the earliest sign, caused by accelerated ventricular repolarization from high potassium levels.
- As potassium rises, it depresses atrial activity and slows AV and ventricular conduction, leading to flat P-waves, a prolonged PR interval, and a widened QRS complex.
- This specific pattern is unique to hyperkalemia and indicates a medical emergency due to the risk of life-threatening arrhythmias.
Why Other Options Were Wrong
- Option A: Hypokalemia (low potassium) presents with different ECG changes.
- Option C: Hypocalcemia (low calcium) primarily affects the QT interval.
- Option D: Hypercalcemia (high calcium) also affects the QT interval, but in the opposite way to hypocalcemia.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to ECG interpretation in electrolyte imbalances to guide bedside assessment, documentation, and the next nursing action.
- Recognizing the ECG pattern of hyperkalemia is a critical, life-saving nursing skill, as it signals an impending risk of cardiac arrest.
- Immediate nursing actions include placing the patient on a cardiac monitor, notifying the provider, and preparing for emergency interventions like administering IV calcium gluconate, insulin, and dextrose.
- What if? If the ECG instead showed ST depression and prominent U-waves, the diagnosis would be hypokalemia. The intervention would be the opposite: administering potassium, not trying to remove it.
How to Approach the Question
- First, identify all the specific ECG abnormalities mentioned in the question: tall peaked T waves, flat P waves, widened QRS, and prolonged PR.
- Systematically recall the classic ECG patterns associated with the four electrolyte imbalances listed in the options.
- Match the observed pattern to the correct condition. The combination of changes affecting the P, PR, QRS, and T waves in this specific manner is uniquely characteristic of hyperkalemia.
- Eliminate the other options by confirming their ECG patterns are different. Hypokalemia involves U-waves, while calcium imbalances primarily affect the QT interval.
Concept Tested & Keywords
- Concept Tested: ECG interpretation in electrolyte imbalances
- Stem keywords: ECG, tall peaked T waves, flat P waves, widened QRS complex, prolonged PR interval
- Lead-in keywords: identifies
Question ID
Q9Q2iBt9Xk41FkdLZo7Wdy
Reference Book
E6 Medicine Harrison 22e Part 1 p. 1915-1917
E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 542-544
Practise the full SCTIMST Staff Nurse - 2015 (Set-A)
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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