A client who takes furosemide presents at the emergency department wit

A client who takes furosemide presents at the emergency department with weakness and fatigue and complains of nausea and vomiting for 3 days.

Upon assessment, the nurse finds that the client has decreased bowel sounds and ECG abnor-malities including a flattened T wave and flattened ST segment. The nurse knows that these are signs of:
1. Hypokalemia
2. Hyperkalemia
3. Hyponatremia
4. Hypocalcemia

ANSWER

ANS: 1
Signs of hypokalemia include weakness and fatigue, muscle weakness, nausea and vomiting, in-testinal distention, decreased bowel sounds, decreased deep tendon reflexes, ventricular dysrhythmias, paresthesias, and weak, irregular pulse. ECG abnormalities: flattened T wave, ST segment depression, U wave, potentiated digoxin effects (e.g., ventricular dysrhythmias). The most common cause of hypokalemia is vomiting and the use of potassium-wasting diuretics. Signs of hyperkalemia include anxiety, dysrhythmias, paresthesia, weakness, abdominal cramps, and diarrhea. ECG abnormalities: peaked T wave and widened QRS complex (bradycardia, heart block, dysrhythmias); eventually QRS pattern widens and cardiac arrest occurs. Signs of hypo-natremia include extreme thirst, dry and flushed skin, dry and sticky tongue and mucous mem-branes, postural hypotension, fever, agitation, convulsions, restlessness, and irritability, whereas signs of hypocalcemia include numbness and tingling of fingers and circumoral (around mouth) region, hyperactive reflexes, positive Trousseau’s sign (carpopedal spasm with hypoxia), positive Chvostek’s sign (contraction of facial muscles when facial nerve is tapped), tetany, muscle cramps, pathological fractures (chronic hypocalcemia), and ECG abnormalities: ventricular tach-ycardia.