Which of the following changes are seen in ECG reading, in patients with Hyperkalemia?

HPSSC Staff Nurse - 2021

Medical Surgical Nursing

Easy

Appeared in: HPSSC Staff Nurse - 2021

Explanation

The correct option is 'All of these' because hyperkalemia causes a cascade of changes to the heart's electrical conduction system that are visible on an ECG.
Initially, hyperkalemia causes accelerated repolarization, leading to tall, peaked T waves and a shortened QT interval.
As potassium levels rise further, conduction slows, resulting in a prolonged PR interval.
Later, more severe changes like flattening of the P wave and widening of the QRS complex occur.
Since all the listed options are valid ECG findings in hyperkalemia, this choice is the most comprehensive and accurate answer.

Option A: This option is a correct statement but incomplete. While tall and peaked T waves are a classic sign of hyperkalemia, other changes also occur.
Option B: This option is a correct statement but incomplete. A shortened QT interval is seen in early hyperkalemia, but it is not the only change.
Option C: This option is a correct statement but incomplete. A prolonged PR interval indicates slowing AV conduction due to hyperkalemia, but other significant changes also happen.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain ECG Interpretation in Electrolyte Imbalances as background academic context rather than a clinical decision trigger.
Recognizing the ECG signs of hyperkalemia is a critical nursing skill, as it is a medical emergency that can lead to fatal cardiac arrhythmias and asystole.
A nurse observing these changes on a cardiac monitor must immediately notify the physician, anticipate orders for emergency treatment (e.g., IV calcium gluconate, insulin and dextrose, Kayexalate), and stop any potassium-containing infusions or medications.
What if the ECG showed prominent U waves, ST depression, and a prolonged QT interval? These findings would suggest the opposite condition, hypokalemia, requiring potassium administration rather than measures to lower potassium.

How to Approach the Question

First, identify the core concept of the question, which is the effect of hyperkalemia on an ECG.
Recall the known sequence of ECG changes associated with elevated potassium levels.
Evaluate each option individually to determine if it is a valid finding in hyperkalemia. You should recognize that tall T-waves, prolonged PR interval, and shortened QT interval are all associated with hyperkalemia.
When you find that multiple individual options are correct, look for a composite option like 'All of these'.
Conclude that since options A, B, and C are all correct manifestations, 'All of these' is the most complete and therefore the best answer.

Concept Tested & Keywords

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

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