In a patient with ESRD awaiting dialysis, a potassium level of 6.8 mEq/L requires which action?

• A. Administer potassium-wasting diuretics
• B. Notify physician immediately
• C. Increase dietary potassium
• D. Delay dialysis

Answer: (B)

High potassium in a patient with end-stage renal disease is a life-threatening emergency because the kidneys can’t excrete the excess potassium, and levels as high as 6.8 mEq/L can trigger dangerous heart rhythms. The nurse’s immediate step is to notify the physician so urgent orders can be written for stabilization and to determine whether emergent dialysis is needed. This situation requires medical management that may include measures to protect the heart and temporarily shift potassium into cells, followed by definitive removal of potassium via dialysis.

Potassium-wasting diuretics won’t help here because there’s little to no kidney function to waste potassium. Increasing dietary potassium would worsen the hyperkalemia, and delaying dialysis would keep the patient at ongoing risk.