JIPMER Pondicherry NO - 2022
Medical & Surgical Nursing
Medium
Which of the following electrolyte imbalance is seen in a patient with CKD, except?
Appeared in: JIPMER Pondicherry NO - 2022
Explanation
- The question asks to identify the electrolyte imbalance that is NOT typically seen in Chronic Kidney Disease (CKD).
- Hypokalemia (low potassium) is the correct answer because CKD impairs the kidneys' ability to excrete potassium.
- This impaired excretion leads to the accumulation of potassium in the blood, a condition known as hyperkalemia (high potassium).
- Therefore, hypokalemia is the exception, as hyperkalemia is the expected finding.
Why Other Options Were Wrong
- Option A: Hyperkalemia (high potassium) is a classic and very common electrolyte imbalance in patients with CKD because the failing kidneys cannot adequately excrete potassium.
- Option B: Hypocalcemia (low calcium) is a common finding in CKD. It results from the kidneys' inability to activate vitamin D (needed for calcium absorption) and high phosphate levels that bind to calcium.
- Option D: This option is incorrect because not all the listed conditions are seen. Hypokalemia is the exception, making 'All of the above' an invalid choice.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to Electrolyte Imbalances in Chronic Kidney Disease (CKD) to guide bedside assessment, documentation, and the next nursing action.
- Nurses must closely monitor serum electrolyte levels in patients with CKD, as imbalances can lead to life-threatening complications, especially cardiac arrhythmias from hyperkalemia.
- Patient education is crucial. Nurses should teach patients with CKD about dietary restrictions, particularly limiting potassium-rich foods (like bananas, oranges, potatoes) to manage hyperkalemia.
- What if? If a CKD patient is also on a potassium-wasting diuretic (like furosemide) for fluid overload, they might develop hypokalemia instead of the typical hyperkalemia. This highlights the need for individualized assessment and monitoring rather than relying solely on the typical disease presentation.
How to Approach the Question
- First, identify the keywords in the question: 'CKD' and 'except'. The word 'except' is critical, meaning you are looking for the option that does NOT fit.
- Recall the normal function of the kidneys, specifically their role in filtering waste and balancing electrolytes like potassium, calcium, and phosphate.
- Think about what happens when kidney function fails in CKD. The kidneys lose their ability to excrete substances.
- Evaluate each option based on the pathophysiology of CKD: Does CKD cause this imbalance? A) Hyperkalemia? Yes, kidneys can't excrete K+. B) Hypocalcemia? Yes, due to lack of active vitamin D and high phosphate. C) Hypokalemia? No, the opposite (hyperkalemia) is expected.
- Since hypokalemia is the opposite of the expected finding, it is the correct 'except' answer.
- Eliminate 'All of the above' as it cannot be correct when one option is clearly the exception.
Concept Tested & Keywords
- Concept Tested: Electrolyte Imbalances in Chronic Kidney Disease (CKD)
- Stem keywords: electrolyte imbalance, CKD, chronic kidney disease
- Lead-in keywords: except
- Negative lead-in flag: Question is negatively framed with 'EXCEPT'
Question ID
Q5fn2CVy0U4br7aeeetkEW
Reference Book
E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 53-55
E6 Nursing Fundamentals Taylor p. 779-781
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