Grant review overview

Original case exhibits · faculty and assessment review

Hyperkalemia in Heart and Kidney Care

Progressive cases and proposed transfer decisions

These original review exhibits make the grant’s teaching method concrete. The existing learner activity and scored assessment are unchanged. New vignettes are proposed parallel forms, not validated instruments or additional completion requirements. Faculty should revise or reject any item that changes the clinical construct or adds unintended difficulty.

Application narrative bank · Proposed transfer items · CSV · Case design map · CSV

Case 1

Evelyn: changed symptoms change the destination

The case develops

A repeat result confirms severe hyperkalemia and new weakness despite an ECG without typical changes.

Faculty reasoning and feedback

Make the urgent disposition decision before discussing longer-term prevention; an ECG cannot justify a delay in this scenario.

Try a different patient

A woman with CKD is contacted about a repeat, nonhemolyzed potassium of 6.7 mmol/L. She reports new weakness; an ECG obtained earlier has no typical hyperkalemic changes. What should happen next?

  1. Arrange emergency assessment and monitored treatment now; confirmation must not delay urgent care.
  2. Start an oral potassium binder at home and repeat testing after the first dose.
  3. Hold the ACE inhibitor and reassess symptoms by telephone in two days.
  4. Repeat the outpatient potassium tomorrow because the ECG is reassuring.
Review the proposed answer and rationale

A. Arrange emergency assessment and monitored treatment now; confirmation must not delay urgent care.

Confirmed severe hyperkalemia with new weakness requires emergency assessment. An ECG without typical changes does not make outpatient delay safe.

Assessment map: baseline K1 → proposed TR1; objective 1. The current course reference list supports the key; verify the current guideline or label during clinical review.

Case 2

Sofia: review contributors before a permanent stop

The case develops

Medication reconciliation reveals a new salt substitute and frequent NSAID use.

Faculty reasoning and feedback

Assess safety, correct reversible contributors and schedule reassessment while explicitly reconsidering the ongoing organ-protection indication.

Try a different patient

A clinically stable woman with albuminuric CKD taking an ARB has repeat potassium values of 5.5 and 5.6 mmol/L. She recently began a potassium-containing salt substitute and frequent ibuprofen. Which initial strategy is most complete?

  1. Address reversible contributors, reassess promptly and individualize potassium-lowering measures while reviewing whether the ARB can safely continue.
  2. Recommend avoiding every fruit and vegetable without changing medicines or arranging laboratory review.
  3. Add spironolactone now to strengthen kidney protection.
  4. Permanently stop the ARB before reviewing other contributors.
Review the proposed answer and rationale

A. Address reversible contributors, reassess promptly and individualize potassium-lowering measures while reviewing whether the ARB can safely continue.

This applies a cause-directed approach with monitoring. Uncontrolled hyperkalemia despite treatment may still require dose reduction or interruption.

Assessment map: baseline K3 → proposed TR2; objective 2. The current course reference list supports the key; verify the current guideline or label during clinical review.

Case 3

Margaret: the best biochemical plan must work at home

The case develops

Edema, low magnesium and multiple morning tablets complicate the long-term binder discussion.

Faculty reasoning and feedback

Compare product-specific cautions, spacing, access and monitoring; do not rank therapies by unrelated trial results or promise emergency rescue.

Try a different patient

A woman with HFrEF and recurrent hyperkalemia is considering a long-term potassium binder. Her medication review identifies edema, low magnesium and several oral drugs taken together each morning. What should guide the shared plan?

  1. Choose solely by which binder enabled a higher MRA dose in a separate trial.
  2. Use the same administration and monitoring schedule for both newer binders.
  3. Review volume and sodium concerns with SZC, magnesium and gastrointestinal concerns with patiromer, medication spacing, access and the monitoring plan.
  4. Choose by the shortest observed potassium response and use it as a home emergency rescue plan.
Review the proposed answer and rationale

C. Review volume and sodium concerns with SZC, magnesium and gastrointestinal concerns with patiromer, medication spacing, access and the monitoring plan.

A patient-specific comparison includes both products’ relevant limitations. Check current full labels and pharmacy advice; neither is an emergency rescue substitute.

Assessment map: baseline K5 → proposed TR3; objective 3. The current course reference list supports the key; verify the current guideline or label during clinical review.

Full proposal, objectives and clinical source register

Review the assessment before release

The current baseline and first posttest share three items. Report paired n, absolute percentage-point change, item-level results and uncertainty, with retries separate. The 15-percentage-point gain is a planning target; high baseline scores may create a ceiling. Repeated items measure immediate learning with recall limitations. The proposed transfer form changes the clinical surface while preserving the mapped concept. Before using it for a Moore level 4 claim, independent clinical and assessment reviewers must approve the key, equivalence, difficulty and analysis, then pilot it with representative learners. Use it to replace matched posttest slots only after approval, preserving six final questions and the time target. It is not an additional required test in the present activity. Report unpaired data and nonresponse; do not infer causality, observed clinical performance or patient benefit.

For each case, check clinical realism, fair balance, one defensible best answer, comparable option length, plausible distractors and absence of irrelevant reading burden. Review safety errors separately. Keep a versioned record of reviewer decisions and pilot findings; unresolved ambiguity blocks use of that item.