The patient is getting potassium correction in 5% dextrose. What ECG changes will the nurse see to stop the infusion?

Appeared in: NORCET 1 - 2020

Explanation

The question asks for the ECG sign that indicates a need to stop a potassium infusion, which points to a complication of the therapy.
Administering IV potassium can lead to iatrogenic hyperkalemia (abnormally high potassium levels).
The earliest and most classic ECG sign of hyperkalemia is the appearance of tall, peaked, or 'tented' T waves.
This change reflects altered cardiac muscle repolarization due to high extracellular potassium.
Recognizing this sign is a critical nursing responsibility to prevent life-threatening cardiac arrhythmias.

Option A: A prominent U wave is a characteristic ECG finding in hypokalemia (low potassium), not hyperkalemia.
Option C: A depressed ST segment is associated with hypokalemia (low potassium) or myocardial ischemia.
Option D: A shallow or flattened T wave is a sign of hypokalemia (low potassium).

Clinical Relevance

Nursing practice connection: Use the key finding related to ECG interpretation in electrolyte imbalances, specifically potassium to guide bedside assessment, documentation, and the next nursing action.
Safe administration of IV potassium is a critical nursing skill that requires constant vigilance.
Nurses must always use an infusion pump for potassium administration and never give it as an IV push, which can be fatal.
Before and during administration, it is crucial to assess the patient's renal function (e.g., urine output, BUN, creatinine), as impaired kidneys cannot excrete potassium, dramatically increasing the risk of hyperkalemia.

How to Approach the Question

First, analyze the clinical scenario: a patient is receiving IV potassium. This is done to correct hypokalemia (low potassium).
Next, identify the core of the question: 'What ECG changes will the nurse see to stop the infusion?' This asks for a sign of a complication or overcorrection.
Reason that overcorrection of hypokalemia leads to its opposite: hyperkalemia (high potassium).
Recall the specific ECG manifestations of hyperkalemia. The earliest sign is a tall, peaked T wave.
Evaluate the options. Eliminate the options that are signs of hypokalemia (prominent U wave, depressed ST segment, shallow T wave).
Select the option that correctly identifies a sign of hyperkalemia.

Concept Tested & Keywords

Concept Tested: ECG interpretation in electrolyte imbalances, specifically potassium.
Stem keywords: potassium correction, 5% dextrose, ECG changes, stop the infusion
Lead-in keywords: What
Clinical cues: The patient is receiving a corrective infusion, which implies a risk of overcorrection.

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E6 Medicine Harrison 22e Part 1 p. 1915-1917

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

Practise the full NORCET 1 - 2020

Attempt every question from this paper in a timed mock, then review the full solution for each one.