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

Appeared in: KPSC Staff Nurse - 2016

Explanation

Hypokalemia (serum potassium less than 3.5 mEq/L) impairs the function of smooth muscles, including those in the gastrointestinal (GI) tract.
This impairment leads to decreased peristalsis (slowed gut motility), which can progress to a non-mechanical bowel obstruction known as paralytic ileus.
The resulting accumulation of gas and fluid within the intestines causes the abdomen to become swollen and distended, a key clinical sign of significant hypokalemia.

Option A: Edema is the result of excess fluid trapped in the body's tissues. It is primarily caused by disturbances in sodium and water balance, not potassium levels.
Option B: Muscle spasms, particularly tetany, are a hallmark sign of hypocalcemia (low calcium) and hypomagnesemia. Hypokalemia's primary effect on skeletal muscle is weakness and flaccidity due to hyperpolarization of muscle cells.
Option C: Kussmaul breathing is a specific pattern of deep, labored breathing that is the body's attempt to compensate for severe metabolic acidosis by blowing off excess carbon dioxide.

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.
Nurses must closely monitor patients at risk for hypokalemia (e.g., those on diuretics, with diarrhea/vomiting) for signs of decreased bowel sounds, constipation, and abdominal distention.
Severe hypokalemia is a medical emergency due to the high risk of life-threatening cardiac arrhythmias (like ventricular tachycardia) and paralytic ileus.
When administering intravenous potassium, it must be diluted and infused slowly using an infusion pump. A rapid IV push of potassium is lethal.

How to Approach the Question

Identify the core concept of the question, which is recognizing a clinical sign of hypokalemia.
Recall the primary physiological role of potassium: It is essential for the electrical function of nerve and muscle cells, including cardiac, skeletal, and smooth muscle.
Consider the effect of a potassium deficit (hypo-kalemia): Low potassium reduces cell excitability, leading to muscle weakness, slowed conduction, and impaired contraction.
Evaluate each option based on this pathophysiology:
Edema is a fluid/sodium issue, not a primary potassium effect.
Muscle spasms indicate hyper-excitability, which is contrary to hypokalemia's effect and more typical of hypocalcemia.

Concept Tested & Keywords

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E6 Medicine Davidson Principles Practice 24e p. 381-383

E6 Medicine Harrison 22e Part 1 p. 397-399

Practise the full KPSC Staff Nurse - 2016

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