A nurse is caring for a client who is taking a glucocorticoid. Which of the following findings should indicate to the nurse the client is experiencing hypokalemia? (Select all that apply.)

Choice A rationale Hypokalemia, a low serum potassium level (normal range 3.5-5.0 mEq/L), directly impacts the resting membrane potential of muscle cells, making them less excitable. This leads to reduced muscle contractility and tone, manifesting as generalized muscle weakness. The electrochemical gradient across the muscle cell membrane is altered, impairing proper nerve impulse transmission and subsequent muscular contraction. Choice B rationale Hyperactive bowel sounds, or borborygmi, are not typically associated with hypokalemia. In fact, severe hypokalemia can cause a reduction in gastrointestinal smooth muscle motility, leading to paralytic ileus, abdominal distention, and hypoactive or absent bowel sounds. The reduced muscle contractility affects all smooth muscle, including that of the intestines. Choice C rationale Tingling of the fingers, or paresthesia, is more commonly associated with hypocalcemia or hyperkalemia rather than hypokalemia. Hypocalcemia (low serum calcium) increases neuromuscular excitability, leading to tingling sensations. In contrast, hypokalemia decreases this excitability, making paresthesia an unlikely symptom. Choice D rationale Peaked T waves on an electrocardiogram (ECG) are a classic sign of hyperkalemia, not hypokalemia. High potassium levels shorten the repolarization phase of the cardiac action potential, causing the T wave to become tall and narrow. Hypokalemia, conversely, often presents with flattened T waves and prominent U waves. Choice E rationale Fatigue is a common and non-specific symptom of hypokalemia. The impaired function of skeletal and smooth muscles, as a result of the altered cellular membrane potentials, requires more energy to perform basic tasks. This leads to a generalized feeling of tiredness and lethargy, contributing to the overall sensation of fatigue.