A nurse is reviewing a new prescription for a client with a serum potassium level of 2.8 m… — NCLEX-RN

A nurse is reviewing a new prescription for a client with a serum potassium level of 2.8 mEq/L (2.8 mmol/L). The prescription reads: "Potassium chloride 40 mEq in 100 mL 0.9% sodium chloride IV to infuse over 4 hours." The client has a 20-gauge peripheral intravenous catheter in the left cephalic vein. Which of the following is the most appropriate action by the nurse?

A
Program an electronic infusion pump to deliver the solution at a continuous rate of 25 mL/hr.
B
Apply a warm compress to the intravenous insertion site during the infusion to prevent venous spasm.
Contact the healthcare provider to request diluting the medication in a larger volume of intravenous fluid.Answer
D
Administer the infusion via gravity using microdrip tubing to ensure the rate does not exceed 10 mEq/hr.

Answer

The correct action is to contact the healthcare provider to request diluting the medication in a larger volume of intravenous fluid.

The correct answer identifies that the prescribed concentration is too high for peripheral administration. The maximum recommended concentration for peripheral administration of intravenous potassium chloride is typically

10 \text{ mEq}

per

100 \text{ mL}

. A concentration of

40 \text{ mEq}

100 \text{ mL}

is highly hyperosmolar and will cause severe pain and chemical phlebitis. The nurse must intervene by requesting the dose be diluted in a larger volume of fluid or by establishing a central venous catheter.

Step-by-Step Solution

Analyze the prescription's medication concentration.

The prescription contains

40 \text{ mEq}

of potassium chloride in

100 \text{ mL}

of fluid.

To determine if the concentration is safe for the designated route of administration.

Evaluate the route of administration.

The client has a peripheral intravenous line in the cephalic vein.

Different vascular access devices have different tolerances for osmolarity and chemical irritation.

Compare the prescribed concentration against safety guidelines for peripheral lines.

The maximum safe peripheral concentration is typically

10 \text{ mEq}

per

100 \text{ mL}

. The prescribed

40 \text{ mEq}

per

100 \text{ mL}

is highly concentrated.

Hyperosmolar and highly concentrated potassium solutions cause severe chemical phlebitis and tissue damage if given peripherally.

Determine the appropriate nursing intervention.

The nurse must withhold the medication and contact the provider for a safer prescription (e.g., diluting the dose in

500 \text{ mL}

1000 \text{ mL}

of fluid).

Nurses are responsible for verifying the safety of all medication prescriptions prior to administration.

Key Concept

Intravenous Potassium Chloride Safety Guidelines

Question

Answer

Step-by-Step Solution

Key Concept

Common Mistakes

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