When assessing a client with kidney failure, the nurse suspects hyperkalemia based on the client's symptoms. Which of the following are signs of hyperkalemia that should be reported to the doctor?

• A. Numbness and tingling in the extremities.
• B. Anxiety, irregular heart rate, and abdominal cramps.
• C. Excessive sweating and tremor.
• D. Severe headache and dizziness.

Answer: (B)

Hyperkalemia disrupts how nerves and muscles work, especially the heart and gut. In kidney failure, potassium can rise high enough to affect cardiac conduction and smooth muscle, so the most important signs to report are those that point to heart rhythm problems and GI involvement.

Anxiety, irregular heart rate, and abdominal cramps fit this pattern well. The irregular heart rate reflects how elevated potassium can slow or alter electrical conduction in the heart, potentially leading to dangerous arrhythmias. Anxiety can accompany palpitations or a sense of something being wrong with the heart, and abdominal cramps come from increased smooth muscle excitability in the GI tract.

Other signs listed are less specific to hyperkalemia. Numbness and tingling are paresthesias that can occur with various conditions, not uniquely signaling hyperkalemia. Sweating and tremor, or severe headache and dizziness, are nonspecific symptoms that can arise from many causes and don’t directly indicate potassium-related cardiac or GI effects.

Given the risk to the patient with kidney failure, reporting the combination of anxiety, an irregular heart rhythm, and abdominal cramps promptly helps address a potentially dangerous electrolyte disturbance.