Hyperkalemia

Intermediate MCQs for Nephrologists

Assess emergency recognition and management of hyperkalemia, ECG toxicity, potassium redistribution, chronic treatment, and dialysis indications.

Hyperkalemia — Intermediate

Difficulty: Intermediate

Test your clinical reasoning in ECG toxicity, emergency treatment, potassium redistribution, medication causes, chronic treatment, and dialysis indications. This quiz contains 10 single-best-answer questions. Explanations are shown after quiz completion.

1 / 10

Which ECG finding is classically associated with early hyperkalemia?

Peaked T waves

U waves

Prolonged QT interval

Diffuse ST elevation

2 / 10

A patient has potassium 7.2 mmol/L with widened QRS complexes. Which treatment should be given immediately to stabilize the cardiac membrane?

Intravenous calcium gluconate

Oral sodium polystyrene sulfonate

Intravenous furosemide only

Insulin without glucose

3 / 10

In a patient with severe hyperkalemia and no contraindication, what is the expected effect of intravenous insulin with glucose?

Redistribution of potassium into cells

Immediate removal of potassium from the body

Increased gastrointestinal potassium absorption

Inhibition of aldosterone secretion

4 / 10

Which medication most commonly causes hyperkalemia by reducing aldosterone-mediated potassium excretion?

Spironolactone

Amlodipine

Furosemide

Doxazosin

5 / 10

A patient with chronic kidney disease has persistent potassium 5.8 mmol/L without ECG changes despite dietary counseling. Which intervention can promote gastrointestinal potassium elimination?

A potassium-binding agent such as patiromer

Intravenous calcium gluconate alone

Sodium bicarbonate in every case

A thiazide-free diet

6 / 10

Which laboratory pattern most strongly suggests pseudohyperkalemia?

High serum potassium with normal plasma potassium and marked hemolysis

High serum and plasma potassium with ECG changes

Low serum potassium with thrombocytopenia

High urine potassium with severe hypokalemia

7 / 10

A patient with diabetic kidney disease has hyperkalemia, normal-anion-gap metabolic acidosis, and low renin activity. Which disorder is most likely?

Type 4 renal tubular acidosis

Distal renal tubular acidosis

Proximal renal tubular acidosis

Respiratory acidosis

8 / 10

After insulin and glucose for severe hyperkalemia, when is rebound hyperkalemia most likely to occur?

After the intracellular shift effect wears off if potassium removal was not achieved

Only after calcium administration

Before insulin has any effect

Never, because insulin removes potassium

9 / 10

A patient with life-threatening hyperkalemia has advanced kidney failure, pulmonary edema, and minimal urine output. Which definitive treatment is most appropriate?

Urgent hemodialysis

Oral calcium carbonate

Observation with repeat ECG tomorrow

Fluid restriction alone

10 / 10

Which dietary counseling point is most appropriate for a patient with recurrent hyperkalemia and CKD?

Review potassium sources and avoid indiscriminate substitution with processed foods containing potassium additives

Avoid all fruits and vegetables permanently

Increase potassium-containing salt substitutes

Use salt substitutes freely because they contain no sodium

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