A nurse is caring for a client with hypokalemia who has a 20-gauge peripheral intravenous … — NCLEX-RN

A nurse is caring for a client with hypokalemia who has a 20-gauge peripheral intravenous (IV) catheter in the right forearm. The healthcare provider prescribes an intravenous infusion of $40\text{ mEq}$ of potassium chloride over 4 hours. The pharmacy delivers a pre-mixed bag containing $40\text{ mEq}$ of potassium chloride in $100\text{ mL}$ of $0.9\%$ sodium chloride. Which of the following is the priority nursing action?

Contact the pharmacy to request the potassium chloride be diluted in a larger volume of fluid.Answer
B
Set the electronic infusion pump to deliver the medication at a rate of $25\text{ mL/hr}$ .
C
Consult a medication reference to verify the compatibility of potassium chloride and $0.9\%$ sodium chloride.
D
Elevate the client's right arm on a pillow during the infusion to promote venous return.

Answer

The correct action is to contact the pharmacy to request the potassium chloride be diluted in a larger volume of fluid.

Intravenous potassium chloride is a high-alert medication that is extremely irritating to the veins. For safe administration through a peripheral intravenous catheter, the maximum recommended concentration is typically

10\text{ mEq}

per

100\text{ mL}

. A concentration of

40\text{ mEq}

100\text{ mL}

is dangerously high and will cause severe pain, chemical phlebitis, and potential tissue necrosis. The priority action is to hold the infusion and contact the pharmacy to have the medication diluted in a larger volume (e.g.,

400\text{ mL}

1000\text{ mL}

) or to request a central venous catheter order if fluid restriction is required.

Step-by-Step Solution

Analyze the prescribed medication and the administration route.

The client is to receive

40\text{ mEq}

of potassium chloride via a peripheral IV catheter.

Identifying the route is essential for evaluating the safety parameters of parenteral medications.

Evaluate the concentration of the delivered medication.

The pharmacy provided

40\text{ mEq}

100\text{ mL}

, which is a concentration of

40\text{ mEq}

per

100\text{ mL}

Potassium chloride is a high-alert medication that is highly irritating to tissues and veins.

Compare the supplied concentration against safe peripheral administration guidelines.

The maximum safe concentration for a peripheral IV is typically

10\text{ mEq}

per

100\text{ mL}

. The supplied bag is far too concentrated.

Infusing a highly concentrated potassium solution peripherally will cause severe pain and chemical phlebitis.

Determine the priority nursing intervention.

The nurse must hold the medication and contact the pharmacy for a properly diluted bag (e.g.,

40\text{ mEq}

400\text{ mL}

or more).

This prevents direct harm to the client from an unsafe pharmacological preparation.

Key Concept

The maximum safe concentration of intravenous potassium chloride for peripheral administration is generally

10\text{ mEq}

per

100\text{ mL}

to prevent severe chemical phlebitis and tissue damage.

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