Module 12: Electrolyte Imbalances (Potassium)

GIT and kidneys

How is potassium lost in the body?

Aldosterone, insulin, glucocorticoids, epinephrine

What factors decrease potassium levels?

Less than 2.5 or more than 7.5 mEq/L

Cardiac arrest is a possible complication when serum potassium is at what level?

Widened QRS complex, tall/peaked T waves, and prolonged PR interval

What ECG changes are present in patients with hyperkalemia?

D

A patient with a serum potassium level of 7.2 mEq/L is admitted to the hospital. The nurse observes the patient has a widened QRS complex and peaked T waves on the ECG. Which intervention should the nurse prioritize?

A. Administer sodium bicarbonate intravenously
B. Monitor the patient’s heart rate and rhythm closely
C. Increase the patient’s potassium intake
D. Administer calcium gluconate intravenously

B

A patient with hyperkalemia (K+ = 6.5 mEq/L) presents with muscle weakness and tingling in their extremities. Which action should the nurse take next?

A. Administer a potassium supplement
B. Assess the patient’s ECG for arrhythmias
C. Increase fluid intake
D. Administer insulin and dextrose

A

A patient with renal failure has a potassium level of 6.2 mEq/L. Which of the following interventions is the priority?

a) Administer 50% dextrose with regular insulin
b) Increase dietary potassium intake
c) Monitor for increased bowel motility
d) Administer Spironolactone

A

A patient with severe hyperkalemia is being treated with sodium polystyrene sulfonate (SPS). The nurse should monitor for which of the following?

a) Abdominal cramping
b) Elevated blood pressure
c) Hypothermia
d) Decreased urine output

IV calcium gluconate

What is given to patients with hyperkalemia to antagonize the effect of potassium in the heart’s conduction system?

5% dextrose with regular insulin (Humulin R)

What is given to patients with hyperkalemia to facilitate the uptake of glucose and potassium in the cell?

IV sodium bicarbonate

What is given to patients with hyperkalemia to cause an increase in pH, promoting the movement of hydrogen ions in the cell and potassium outside?

Sodium polystyrene sulfonate or Kayexalate PO/enema

What are given to patients with hyperkalemia, promoting the exchange of potassium and sodium ions in the GI tract and the excretion of potassium ions in the stool?

Urine output (BUN, creatinine)

What should be checked before giving potassium?

C

A patient with hyperkalemia is at risk for respiratory failure. The nurse should be alert for which of the following signs?

a) Muscle twitching
b) Nausea and vomiting
c) Muscle weakness and flaccid paralysis
d) Abdominal cramping

A

A patient with hyperkalemia and metabolic acidosis is receiving treatment. What is the mechanism behind the treatment?

a) Insulin promotes the shift of potassium into cells.
b) Calcium gluconate increases the excretion of potassium.
c) Sodium bicarbonate decreases potassium reabsorption in the kidneys.
d) Sorbitol enhances potassium retention in the intestines.

B

A patient with hyperkalemia has been prescribed a low-potassium diet. Which food should the nurse instruct the patient to avoid?

a) Carrots
b) Spinach
c) Apples
d) Chicken

B

In which patient situation should the nurse closely monitor potassium levels to prevent hyperkalemia?

a) Patient with diarrhea
b) Patient taking ACE inhibitors
c) Patient with hypertension
d) Patient with a low-fat diet

D

Which of the following is a potential cause of hyperkalemia?

a) Dehydration
b) Diabetes
c) Hypertension
d) Bowel obstruction

Hemodialysis

What is the most effective treatment for hyperkalemia due to kidney failure?

C

A patient with hyperkalemia complains of intermittent muscle cramps and tingling in the extremities. What should the nurse consider when assessing the severity of these symptoms?

a) The patient may be developing flaccid paralysis.
b) These symptoms are likely related to dehydration.
c) The patient is likely in the early stages of hyperkalemia.
d) These symptoms are unrelated to potassium imbalances.

A

Which of the following is a primary cardiac manifestation of hyperkalemia?

a) Bradycardia
b) Tachycardia
c) Hyperactive bowel sounds
d) Hyperventilation

Hypocalcemia

What should be watched out for when giving sodium bicarbonate in patients with hyperkalemia?

Prominent U wave, ST segment depression, flat/depressed T wave, PVC, heart block

What ECG changes are present in patients with hypokalemia?

C

Which intervention is critical when administering IV potassium chloride to a client with hypokalemia?

A. Infuse the solution rapidly to prevent cardiac complications
B. Administer it via IV push for quicker action
C. Dilute the potassium and infuse it using a pump
D. Mix potassium chloride with dextrose-containing fluids

A

A client with Cushing syndrome is at risk for hypokalemia. What is the primary cause of hypokalemia in this condition?

A. Increased potassium loss via urine
B. Decreased potassium intake
C. Increased GI losses
D. Increased potassium absorption

B

Which laboratory result should the nurse anticipate in a client with hypokalemia caused by metabolic alkalosis?

A. pH <7.35, elevated bicarbonate
B. pH >7.45, elevated bicarbonate
C. pH <7.35, low bicarbonate
D. pH >7.45, low bicarbonate

B

A nurse notices a flat T wave and ST depression on the client’s ECG. Which immediate intervention is appropriate?

A. Monitor magnesium levels
B. Initiate potassium supplementation
C. Discontinue diuretics
D. Obtain arterial blood gases

B

A client with diabetes mellitus is admitted with diabetic ketoacidosis. Why is this client at risk for hypokalemia after insulin administration?

A. Insulin decreases serum potassium levels by renal excretion
B. Insulin promotes potassium entry into cells
C. Insulin binds potassium to glucose
D. Insulin decreases gastrointestinal potassium absorption

C

Which symptom is most indicative of hypokalemia?

A. Flushing
B. Bradycardia
C. Muscle cramps
D. Diaphoresis

D

Why should IV potassium not be given by IV push?

A. Risk of tissue necrosis
B. Risk of delayed absorption
C. Risk of metabolic acidosis
D. Risk of hyperkalemia and cardiac arrest

A

What is the most appropriate nursing action when administering potassium chloride orally?

A. Administer it with meals to prevent GI upset
B. Crush the tablet for easy swallowing
C. Mix with acidic juice to increase absorption
D. Administer on an empty stomach

Hypomagnesemia

What electrolyte imbalance often accompanies hypokalemia?

B

A client with a potassium level of 2.8 mEq/L is experiencing constipation and hypoactive bowel sounds. What pathophysiological mechanism explains this finding?

A. Increased serum potassium affects peristalsis
B. Decreased potassium impairs smooth muscle contractions
C. Potassium excess inhibits gastric secretions
D. Hypokalemia causes vasoconstriction of intestinal vessels

A

A nurse assesses a client with hypokalemia and finds shallow respirations and decreased breath sounds. What should the nurse prioritize next?

A. Monitor oxygen saturation
B. Assess for ECG changes
C. Prepare for intubation
D. Evaluate for signs of metabolic acidosis

A

A client is diagnosed with hyperaldosteronism. How does this condition contribute to hypokalemia?

A. Excess aldosterone increases potassium excretion by the kidneys
B. Aldosterone reduces GI absorption of potassium
C. Increased aldosterone promotes potassium movement into cells
D. Aldosterone causes a loss of both sodium and potassium

B

The client has been vomiting for three days and is diagnosed with metabolic alkalosis. How is hypokalemia related to this condition?

A. Vomiting directly removes potassium from the bloodstream
B. Alkalosis causes potassium to shift from the blood into cells
C. Vomiting stimulates aldosterone secretion, leading to hypokalemia
D. Metabolic alkalosis increases renal excretion of potassium

B

A client is admitted with a history of thyrotoxicosis. Why is this client at risk for hypokalemia?

A. Increased metabolism promotes potassium excretion in the urine
B. Elevated thyroid hormones drive potassium into the cells
C. Thyrotoxicosis reduces dietary potassium intake
D. Hyperthyroidism increases aldosterone secretion

B

What is the primary source of potassium loss in a client with prolonged diarrhea?

A. Renal excretion
B. Gastrointestinal secretions
C. Cellular metabolism
D. Hormonal imbalance

C

Which symptom is least likely associated with hypokalemia?

A. Leg cramps
B. Bradycardia
C. Hyperreflexia
D. Paralytic ileus

Aldosterone

What hormone is directly responsible for promoting potassium excretion?