# A client with chronic kidney disease has potassium 6.4 mEq/L. Click the ECG finding most consistent with early hyperkalemia.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=397540&lang=en  
> language: en  
> subject: Postsurgical Complications  
> category: ROR

## Question

A client with chronic kidney disease has potassium 6.4 mEq/L. Click the ECG finding most consistent with early hyperkalemia.

![](https://mymerci.kr/data/nclex/hotspot/v2/v2_ecg_hyperkalemia.png)

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## Explanation

Peaked T wave is the best answer. Tall peaked T waves are a classic early ECG manifestation of hyperkalemia. Other marked areas do not best match the cue in this item.

## In-depth explanation

Quick answer
Peaked T wave is the best answer. Tall peaked T waves are a classic early ECG manifestation of hyperkalemia. Other marked areas do not best match the cue in this item.

Why this is correct
Potassium affects cardiac membrane repolarization. In early hyperkalemia, the T wave can become tall and narrow before more advanced conduction changes appear.

Easy analogy or mental picture
Picture the ECG in sequence: the T wave sharpens first, then worsening toxicity can disturb atrial and ventricular conduction. The question asks for the early visual clue, not every possible late change.

Memory hook
High potassium plus an early ECG change points to a tall peaked T wave.

NCLEX decision rule
When elevated potassium is paired with an ECG image, inspect the T wave first and then assess the rest of the conduction pattern and the client's stability.

Why the other choices are wrong
Selecting the P wave, QRS complex, or ST segment alone misses the early repolarization clue identified in this item.References

- [1]NCBI Bookshelf: Hyperkalemia

## Clinical scenario

Clinical situation
A client with chronic kidney disease has potassium 6.4 mEq/L.

What the nurse should notice
Peaked T wave is the best answer. Tall peaked T waves are a classic early ECG manifestation of hyperkalemia. Other marked areas do not best match the cue in this item.

Transfer to practice
When elevated potassium is paired with an ECG image, inspect the T wave first and then assess the rest of the conduction pattern and the client's stability.

## Key concepts

- **Hyperkalemia** — Elevated serum potassium.
- **Repolarization** — The electrical recovery phase represented largely by the T wave.
- **QRS widening** — Severe conduction change.

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