Which of the following electrocardiogram finding would be seen in a client with Hyperkalemia?

Appeared in: NORCET 5 Prelims - Sept 2023 (Shift-1)

Explanation

A widened QRS complex (greater than 0.12 seconds) is a significant ECG finding in moderate to severe hyperkalemia (typically when serum K+ is above 6.5 mEq/L).
Elevated extracellular potassium slows the depolarization of cardiac muscle cells, particularly in the ventricles, leading to delayed and slower conduction of the electrical impulse.
This slowing of intraventricular conduction is visualized as a widening of the QRS complex on the ECG.
As shown in the provided image, the QRS is clearly widened, which is a critical warning sign of impending life-threatening arrhythmias like ventricular fibrillation or asystole.

Option A: ST depression is not a primary sign of hyperkalemia. It indicates a disturbance in ventricular repolarization.
Option B: Hyperkalemia causes tall, peaked T waves due to faster repolarization. T-wave inversion is not associated with it.
Option D: A flat T wave is the opposite of the expected finding in hyperkalemia. Hyperkalemia is characterized by tall, peaked T waves.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain ECG Interpretation in Hyperkalemia as background academic context rather than a clinical decision trigger.
Recognizing ECG changes of hyperkalemia is a critical nursing skill, as it is a medical emergency that can lead to cardiac arrest. Prompt identification allows for immediate intervention.
A nurse's primary role includes continuous cardiac monitoring for patients at risk for hyperkalemia (e.g., those with renal failure, on potassium-sparing diuretics, or with crush injuries), reporting critical ECG changes to the physician, and preparing for emergency treatment.
Emergency treatment may include administering intravenous calcium gluconate to stabilize the cardiac membrane, insulin with dextrose to shift potassium into cells, and sodium bicarbonate if acidosis is present.

How to Approach the Question

First, identify the key terms in the question: 'electrocardiogram finding' and 'Hyperkalemia'. This directs you to recall the specific ECG changes associated with high potassium levels.
Mentally review the progression of ECG changes in hyperkalemia: Peaked T waves → Prolonged PR → Flattened P wave → Widened QRS → Sine wave.
Evaluate each option against this knowledge. 'ST depression' and 'Flat T wave' are associated with hypokalemia. 'Inverted T wave' is usually linked to ischemia.
Recognize that 'Widened QRS complex' is a key part of the progression for moderate-to-severe hyperkalemia.
If an image is provided, analyze it for these classic signs. The image here confirms the presence of a widened QRS, reinforcing the correct answer.

Concept Tested & Keywords

QBCK21JhgXuH9Y0ixIR-_q

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

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

Practise the full NORCET 5 Prelims - Sept 2023 (Shift-1)

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