Introduction
Scenario setup
A 72-year-old with CKD reports weakness and palpitations. K+ 6.2 mEq/L, ECG shows peaked T waves in clinic.
NP ambulatory decision: ED referral for ECG-positive hyperkalemia versus attempting outpatient tricks—most items favor urgent evaluation with continuous monitoring capability. NP traps: oral kayexalate alone as sole plan for severe changes; ignoring ECG. This case-study format is intentional: boards reward trajectory thinking—what changed, what is unstable, and what you do next for the role named in the stem. For NP certification preparation (United States), read the assignment line before you eliminate answers. Slow read: re-scan the stem for vitals trends, oxygen settings, allergies, and time since onset—case items often hide the decisive clue in a single line. On the exam, writers often pair stable-sounding options with unstable data—notice the mismatch before you commit. If the stem names a license or role, reread that line; scope errors are classic trap answers even when the clinical topic is familiar. Run a 60-second scan: breathing work and oxygenation, perfusion and end organs, neuro baseline, likely infection sources, and devices that can fail quietly.