A patient with severe hyperkalemia from renal failure has which assessment as the first priority?

• A. Blood pressure
• B. Respirations
• C. Temperature
• D. Pulse

Answer: (D)

In severe hyperkalemia, the most dangerous threat is to the heart’s electrical system. Potassium overload can rapidly produce life-threatening rhythm disturbances and even cardiac arrest. Because of that, the first assessment is the pulse to quickly gauge cardiac stability. A weak, slow, or irregular pulse signals potential dysrhythmia and prompts immediate action, including continuous ECG monitoring and rapid interventions to stabilize the heart and lower potassium. Respirations, temperature, and blood pressure are important, but they don’t reveal the imminent risk to cardiac function as directly as detecting a concerning pulse does in this situation.