A nurse is caring for a client who has named a person to serve as his health care proxy. The client talks about this type of advance directives. Which of the following statements by the client indicates a need for clarification?

A. Open the airway using a jaw-thrust maneuver: The first step in a primary survey is to assess the airway and ensure it is open. The jaw-thrust maneuver is used to open the airway without moving the neck in case of a potential cervical spine injury.

C. Determine effectiveness of ventilator efforts: Once the airway is open, the next step is to assess breathing. This includes observing for chest rise and fall, listening for breath sounds, and feeling for air movement.

B. Establish IV access: After the airway and breathing have been assessed, circulation is the next priority. This includes establishing IV access for fluid and medication administration.

D. Perform a Glasgow Coma Scale assessment: The Glasgow Coma Scale is used to assess the client’s level of consciousness, which is part of the disability assessment in the primary survey.

E. Remove clothing for a thorough assessment: Finally, removing the client’s clothing allows for a thorough assessment of injuries. This is typically done after the immediate life-threatening issues have been addressed.

A. Inverted P wave: An inverted P wave may indicate atrial depolarization abnormalities but is not typically associated with hypokalemia. It can be seen in conditions such as atrial enlargement or atrial ischemia. However, in hypokalemia, the P wave may become flattened or have a decreased amplitude, but it is less likely to be inverted.
B. Wide QRS: A wide QRS complex may indicate conduction abnormalities or bundle branch blocks, but it is not specifically associated with hypokalemia. Wide QRS complexes are more commonly seen in conditions such as bundle branch blocks or electrolyte imbalances like hyperkalemia. Hypokalemia tends to cause a prolongation of the QT interval rather than widening of the QRS complex.
C. Elevated ST segment: An elevated ST segment is typically associated with myocardial injury or infarction, not hypokalemia. It can be indicative of conditions such as myocardial ischemia or pericarditis. In hypokalemia, ST segment changes are more likely to be flattened or depressed rather than elevated.
D. Abnormally prominent U wave: An abnormally prominent U wave is a classic EKG finding in hypokalemia. Hypokalemia prolongs the repolarization phase of the cardiac action potential, leading to the appearance of U waves following the T wave. These U waves can become more pronounced as potassium levels decrease. Therefore, an abnormally prominent U wave is a significant indicator of hypokalemia on an EKG, especially in a patient with prolonged vomiting, which can lead to potassium depletion. Thus, it is the most pertinent abnormality to interpret in this context.