Which of the following clinical finding indicates the patient is experiencing hypokalemia?

RRB Staff Nurse Ahmedabad-2015

Medical & Surgical Nursing

Easy

Appeared in: RRB Staff Nurse Ahmedabad-2015

Explanation

Hypokalemia (low serum potassium) impairs the function of smooth, skeletal, and cardiac muscles.
In the gastrointestinal tract, this impairment of smooth muscle leads to decreased motility and peristalsis.
Severe hypokalemia can cause a functional bowel obstruction known as paralytic ileus.
The clinical manifestation of paralytic ileus includes nausea, vomiting, constipation, and significant abdominal distention.

Option A: Edema (fluid accumulation in tissues) is a sign of fluid volume excess or altered protein levels, not directly caused by potassium deficiency.
Option B: Hypokalemia leads to muscle weakness, fatigue, and decreased deep tendon reflexes (hyporeflexia), not spasms.
Option C: Kussmaul breathing is a deep, rapid respiratory pattern that is a compensatory mechanism for severe metabolic acidosis (e.g., diabetic ketoacidosis).

Visual 1: ECG Strip - Shows the characteristic ECG changes in hypokalemia, such as flattened T-waves, ST depression, and the presence of a prominent U-wave.
Visual 2: Diagram - Illustrates the mechanism of paralytic ileus, showing a distended, non-motile bowel resulting from smooth muscle paralysis in hypokalemia.

Clinical Relevance

Nursing practice connection: Use the key finding related to Clinical manifestations of hypokalemia to guide bedside assessment, documentation, and the next nursing action.
The nursing priority for a patient with significant hypokalemia is monitoring for life-threatening cardiac arrhythmias and respiratory insufficiency.
Patient safety during IV potassium replacement is critical. Potassium must be diluted, administered via an infusion pump, and never given as an IV push, as this can cause cardiac arrest.
What if? - If the patient had hyperkalemia (high potassium) instead, the nurse would assess for opposite signs like muscle twitching, cramping, diarrhea, and peaked T-waves on the ECG.

How to Approach the Question

Step 1: Identify the core concept in the question, which is the clinical findings of 'hypokalemia' (low potassium).
Step 2: Recall the primary function of potassium in the body, focusing on its role in muscle (skeletal, smooth, cardiac) and nerve function. Remember the mnemonic: 'Potassium is pumped' for muscle and nerve action potential.
Step 3: Systematically evaluate each option based on the pathophysiology of hypokalemia. Think 'low and slow' for many hypokalemia symptoms.
Step 4: Analyze 'Abdominal distention'. Low potassium slows smooth muscle contraction, leading to decreased gut motility (paralytic ileus) and subsequent distention. This is a known sign.
Step 5: Analyze the distractors. 'Edema' is a fluid balance issue. 'Muscle spasms' are typical of hypocalcemia. 'Kussmaul breathing' is related to metabolic acidosis. None of these are primary signs of hypokalemia.
Step 6: Conclude that abdominal distention is the most accurate clinical finding of hypokalemia among the choices.

Concept Tested & Keywords

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