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Difficulty: MediumPharmacological and Parenteral Therapies

The unit nurse is reviewing a new medication prescription for an adult client with a serum potassium level of 2.8 mEq/L. The prescription reads: 'Potassium chloride 40 mEq in 100 mL 0.9% sodium chloride IV piggyback over 2 hours.' The client currently has a continuous normal saline infusion running through a 20-gauge peripheral catheter in the left forearm. What is the priority nursing action?

  1. Withhold the medication and immediately contact the healthcare provider to report the unsafe concentration and rate.Answer
  2. B
    Obtain a secondary infusion pump and program the rate to deliver the medication precisely over 120 minutes.
  3. C
    Verify compatibility between the potassium chloride solution and the primary normal saline infusion.
  4. D
    Assess the client's recent urine output to ensure adequate renal clearance before initiating the infusion.

Answer

The nurse must withhold the medication and immediately contact the healthcare provider to report the unsafe concentration and rate.
The ordered dose of 40 mEq of potassium chloride in 100 mL of fluid to be infused over 2 hours is entirely unsafe for a peripheral intravenous line. The maximum recommended peripheral concentration is typically 10 mEq per 100 mL (100 mEq/L), and the maximum safe peripheral infusion rate is 10 mEq per hour. Administering this high concentration peripherally will cause severe phlebitis, pain, and tissue damage, while the excessive rate places the client at high risk for fatal cardiac dysrhythmias. The nurse must recognize this lethal prescription and intervene immediately by contacting the provider.

Step-by-Step Solution

1
Analyze the prescribed medication parameters (dose, diluent volume, and infusion duration).
The provider ordered 40 mEq of potassium chloride in 100 mL of fluid to infuse over 2 hours via a peripheral IV.
Evaluating high-alert medication parameters against established safety guidelines is the first step in ensuring parenteral therapy safety.
2
Compare the calculated concentration and rate against maximum safe peripheral administration limits.
The ordered concentration is 40 mEq/100 mL and the rate is 20 mEq/hr. The maximum safe peripheral concentration is typically 10 mEq/100 mL, and the maximum safe peripheral rate is 10 mEq/hr.
Intravenous potassium chloride can cause life-threatening cardiac arrhythmias and severe local phlebitis if administered too rapidly or in an overly concentrated solution.
3
Determine the priority nursing intervention based on the identified discrepancy.
The nurse must not administer the medication as ordered and must contact the provider to request a safe dilution (e.g., in 500-1000 mL) or a central line placement.
The nurse has a legal and ethical obligation to question unsafe medical prescriptions and prevent immediate client harm.

Key Concept

Safe administration limits for intravenous potassium chloride
Estimated Time:1m 30s
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Topics

Pharmacological and Parenteral Therapies

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