The management of electrolyte disorders is a fundamental and often life-saving responsibility for pharmacists in any clinical setting. These imbalances can lead to severe cardiac, neurological, and neuromuscular complications, making prompt recognition and appropriate treatment essential. As detailed in the Patient Care 4 curriculum, a pharmacist must be adept at interpreting lab values and recommending targeted therapies for the full spectrum of electrolyte abnormalities. This quiz will test your knowledge on the causes, symptoms, and management of these critical conditions.
1. A patient presents with a serum potassium of 6.8 mEq/L and peaked T-waves on their ECG. What is the most appropriate first-line medication to administer immediately?
- a. IV Insulin and dextrose
- b. IV Sodium polystyrene sulfonate
- c. IV Calcium gluconate
- d. IV Furosemide
Answer: c. IV Calcium gluconate
2. What is the primary purpose of administering IV calcium in the setting of severe hyperkalemia?
- a. It rapidly lowers the serum potassium level.
- b. It stabilizes the cardiac membrane to protect against arrhythmias.
- c. It increases the renal excretion of potassium.
- d. It shifts potassium into the intracellular space.
Answer: b. It stabilizes the cardiac membrane to protect against arrhythmias.
3. Rapid overcorrection of chronic hyponatremia with hypertonic saline can lead to what severe neurological complication?
- a. Cerebral edema
- b. Osmotic demyelination syndrome
- c. Wernicke’s encephalopathy
- d. Aseptic meningitis
Answer: b. Osmotic demyelination syndrome
4. A patient taking a high dose of a loop diuretic like furosemide is at risk for which of the following electrolyte abnormalities?
- a. Hyperkalemia and Hypermagnesemia
- b. Hypokalemia and Hypomagnesemia
- c. Hyperphosphatemia
- d. Hypercalcemia
Answer: b. Hypokalemia and Hypomagnesemia
5. The “Management of Electrolyte Abnormalities” is a specific learning module in which course?
- a. PHA5784C Patient Care 4
- b. PHA5104 Sterile Compounding
- c. PHA5703 Pharmacy Law and Ethics
- d. PHA5878C Patient Care 3
Answer: a. PHA5784C Patient Care 4
6. A patient has a serum calcium of 7.5 mg/dL and an albumin of 2.0 g/dL. What is the corrected calcium level? (Corrected Ca = Measured Ca + [0.8 * (4.0 – Albumin)])
- a. 7.5 mg/dL
- b. 8.5 mg/dL
- c. 9.1 mg/dL
- d. 9.9 mg/dL
Answer: c. 9.1 mg/dL
7. Chvostek’s sign and Trousseau’s sign are physical exam findings associated with:
- a. Hyperkalemia
- b. Hyponatremia
- c. Hypocalcemia
- d. Hyperphosphatemia
Answer: c. Hypocalcemia
8. Which of the following is NOT a treatment strategy for acutely lowering serum potassium?
- a. IV Insulin and dextrose
- b. Nebulized albuterol
- c. IV Calcium chloride
- d. IV Potassium chloride
Answer: d. IV Potassium chloride
9. What is the maximum recommended infusion rate for potassium chloride through a peripheral IV line to avoid pain and phlebitis?
- a. 5 mEq/hour
- b. 10 mEq/hour
- c. 20 mEq/hour
- d. 40 mEq/hour
Answer: b. 10 mEq/hour
10. A patient with Chronic Kidney Disease (CKD) is at high risk for which electrolyte abnormality?
- a. Hypokalemia
- b. Hyperphosphatemia
- c. Hypophosphatemia
- d. Hyponatremia
Answer: b. Hyperphosphatemia
11. The pharmacology of diuretics, which significantly impact electrolytes, is a topic in the Patient Care 3 curriculum.
- a. True
- b. False
Answer: a. True
12. A patient with hypervolemic hyponatremia (e.g., from heart failure) should be managed with:
- a. Large volumes of 0.9% NaCl.
- b. Fluid restriction and diuretics.
- c. Oral salt tablets.
- d. 3% NaCl infusion.
Answer: b. Fluid restriction and diuretics.
13. A patient with severe hypomagnesemia is at risk for which life-threatening arrhythmia?
- a. Atrial fibrillation
- b. Sinus bradycardia
- c. Torsades de Pointes
- d. First-degree AV block
Answer: c. Torsades de Pointes
14. A patient with CKD is prescribed calcium acetate as a phosphate binder. How should this medication be administered?
- a. On an empty stomach.
- b. At bedtime.
- c. With meals to bind dietary phosphate.
- d. Once a week.
Answer: c. With meals to bind dietary phosphate.
15. Which electrolyte abnormality can cause muscle weakness, respiratory failure, and rhabdomyolysis, and is often seen in refeeding syndrome?
- a. Severe hypophosphatemia
- b. Mild hypercalcemia
- c. Hypermagnesemia
- d. Mild hyponatremia
Answer: a. Severe hypophosphatemia
16. Long-term use of a proton pump inhibitor (PPI) can lead to a deficiency of which electrolyte?
- a. Potassium
- b. Sodium
- c. Magnesium
- d. Chloride
Answer: c. Magnesium
17. The renal system module in Patient Care 4 covers the management of electrolyte disorders.
- a. True
- b. False
Answer: a. True
18. A patient presents with confusion, thirst, and a serum sodium of 158 mEq/L. This condition is:
- a. Hyponatremia
- b. Hypernatremia
- c. Hypokalemia
- d. Hyperkalemia
Answer: b. Hypernatremia
19. What is the most appropriate fluid for treating hypernatremia caused by free water deficit?
- a. 0.9% NaCl
- b. Lactated Ringer’s
- c. 3% NaCl
- d. D5W or oral free water
Answer: d. D5W or oral free water
20. An active learning session on managing electrolyte abnormalities is part of the Patient Care 4 curriculum.
- a. True
- b. False
Answer: a. True
21. Spironolactone is a potassium-sparing diuretic. A patient taking this medication is at risk for:
- a. Hypokalemia
- b. Hyperkalemia
- c. Hyponatremia
- d. Hypomagnesemia
Answer: b. Hyperkalemia
22. Which two electrolytes often need to be replaced together, as deficiency of one impairs the correction of the other?
- a. Sodium and Chloride
- b. Potassium and Magnesium
- c. Calcium and Phosphate
- d. Sodium and Potassium
Answer: b. Potassium and Magnesium
23. A patient with hypercalcemia of malignancy may be treated with IV hydration, calcitonin, and which other class of medication for long-term control?
- a. A loop diuretic
- b. A bisphosphonate
- c. An ESA
- d. A thiazide diuretic
Answer: b. A bisphosphonate
24. Which of the following is NOT a treatment for hyperkalemia?
- a. Sodium polystyrene sulfonate
- b. Patiromer
- c. Albuterol
- d. Spironolactone
Answer: d. Spironolactone
25. A patient’s serum potassium is 2.9 mEq/L. This is considered:
- a. Normal
- b. Mild hypokalemia
- c. Moderate-to-severe hypokalemia
- d. Hyperkalemia
Answer: c. Moderate-to-severe hypokalemia
26. A patient with SIADH (Syndrome of Inappropriate Antidiuretic Hormone) would be expected to have what type of hyponatremia?
- a. Hypovolemic hyponatremia
- b. Euvolemic hyponatremia
- c. Hypervolemic hyponatremia
- d. Pseudohyponatremia
Answer: b. Euvolemic hyponatremia
27. What is the role of a pharmacist in managing electrolyte disorders?
- a. Recommending appropriate replacement therapies and calculating doses.
- b. Identifying drug-induced electrolyte abnormalities.
- c. Counseling on dietary modifications.
- d. All of the above.
Answer: d. All of the above.
28. An active learning session on the renal system, including electrolytes, is part of which course?
- a. PHA5784C Patient Care 4
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5784C Patient Care 4
29. Which of the following can cause a shift of potassium into the cells, leading to hypokalemia?
- a. Acidosis
- b. Insulin administration
- c. A beta-blocker
- d. Digoxin toxicity
Answer: b. Insulin administration
30. The administration of IV insulin for hyperkalemia must always be accompanied by what other agent to prevent a serious adverse effect?
- a. Dextrose
- b. Calcium
- c. Sodium bicarbonate
- d. Furosemide
Answer: a. Dextrose
31. Sevelamer is a phosphate binder that offers what advantage over calcium-based binders in patients with CKD?
- a. It is less expensive.
- b. It does not contribute to the patient’s calcium load, reducing the risk of hypercalcemia and vascular calcification.
- c. It is more effective at binding phosphate.
- d. It is dosed once daily.
Answer: b. It does not contribute to the patient’s calcium load, reducing the risk of hypercalcemia and vascular calcification.
32. A patient with severe, symptomatic hypocalcemia should be treated with:
- a. Oral calcium tablets
- b. A high-calcium diet
- c. IV calcium gluconate
- d. A thiazide diuretic
Answer: c. IV calcium gluconate
33. Thiazide diuretics can cause which electrolyte abnormality, which may be beneficial in patients with osteoporosis?
- a. Hypocalcemia
- b. Hypercalcemia
- c. Hyperkalemia
- d. Hypermagnesemia
Answer: b. Hypercalcemia
34. The maximum amount of sodium correction in a 24-hour period for chronic hyponatremia is generally:
- a. 2-4 mEq/L
- b. 4-6 mEq/L
- c. 8-10 mEq/L
- d. 20-25 mEq/L
Answer: c. 8-10 mEq/L
35. A patient with hypermagnesemia may present with what physical exam finding?
- a. Hyperreflexia
- b. Tachycardia
- c. Loss of deep tendon reflexes
- d. Hypertension
Answer: c. Loss of deep tendon reflexes
36. Which of the following is NOT a cause of hypokalemia?
- a. Diarrhea
- b. Use of ACE inhibitors
- c. Use of loop diuretics
- d. Vomiting
Answer: b. Use of ACE inhibitors
37. The choice between calcium chloride and calcium gluconate for IV administration often depends on:
- a. The patient’s potassium level.
- b. The type of IV access (central vs. peripheral), as calcium chloride is more irritating.
- c. The patient’s age.
- d. The cost of the drug.
Answer: b. The type of IV access (central vs. peripheral), as calcium chloride is more irritating.
38. The management of electrolyte abnormalities is covered in the renal system module.
- a. True
- b. False
Answer: a. True
39. A patient with tumor lysis syndrome is at high risk for:
- a. Hyperkalemia, hyperphosphatemia, and hypocalcemia.
- b. Hypokalemia, hypophosphatemia, and hypercalcemia.
- c. Hyponatremia only.
- d. Normal electrolyte levels.
Answer: a. Hyperkalemia, hyperphosphatemia, and hypocalcemia.
40. An active learning session covering electrolyte disorders is part of the Patient Care 4 course.
- a. True
- b. False
Answer: a. True
41. Which of the following can be used to remove potassium from the body?
- a. Insulin
- b. Albuterol
- c. Sodium polystyrene sulfonate (Kayexalate)
- d. Calcium gluconate
Answer: c. Sodium polystyrene sulfonate (Kayexalate)
42. A patient with hypovolemic hyponatremia should be treated with:
- a. Fluid restriction
- b. A loop diuretic
- c. Isotonic saline (0.9% NaCl) to restore volume.
- d. A vasopressin antagonist.
Answer: c. Isotonic saline (0.9% NaCl) to restore volume.
43. A patient with severe symptoms of hypophosphatemia would be treated with:
- a. Oral phosphate
- b. IV potassium phosphate or sodium phosphate
- c. A high-phosphate diet
- d. A phosphate binder
Answer: b. IV potassium phosphate or sodium phosphate
44. What is a key counseling point for a patient taking a potassium supplement tablet?
- a. Crush or chew the tablet for better absorption.
- b. Take it with a full glass of water and remain upright for a period to prevent esophageal irritation.
- c. Take it on an empty stomach.
- d. It can be taken with antacids.
Answer: b. Take it with a full glass of water and remain upright for a period to prevent esophageal irritation.
45. Which of the following is a symptom of hyponatremia?
- a. Thirst
- b. Headache, nausea, and confusion
- c. Dry mucous membranes
- d. Tachycardia
Answer: b. Headache, nausea, and confusion
46. The normal physiological range for serum potassium is approximately:
- a. 1.5-2.5 mEq/L
- b. 3.5-5.0 mEq/L
- c. 8.5-10.5 mEq/L
- d. 135-145 mEq/L
Answer: b. 3.5-5.0 mEq/L
47. A patient taking amphotericin B is at high risk for which electrolyte abnormalities?
- a. Hyperkalemia and Hypermagnesemia
- b. Hypokalemia and Hypomagnesemia
- c. Hyponatremia
- d. Hyperphosphatemia
Answer: b. Hypokalemia and Hypomagnesemia
48. An active learning session on electrolyte abnormalities is part of which course module?
- a. Module 7: Renal System
- b. Module 1: PUD and GERD
- c. Module 4: Gastrointestinal Infections
- d. Module 5: Nutrition & Weight Management
Answer: a. Module 7: Renal System
49. The overall goal of managing electrolyte disorders is to:
- a. Make the lab values look perfect.
- b. Prevent and treat life-threatening complications while safely restoring normal balance.
- c. Use as many IV products as possible.
- d. Discharge the patient from the hospital quickly.
Answer: b. Prevent and treat life-threatening complications while safely restoring normal balance.
50. The ultimate reason for a pharmacist to master the management of electrolyte disorders is to:
- a. Pass the NAPLEX.
- b. Prevent significant patient morbidity and mortality through safe and effective medication use.
- c. Be able to order and interpret all lab tests.
- d. Show proficiency in calculations.
Answer: b. Prevent significant patient morbidity and mortality through safe and effective medication use.