A charge nurse is observing a newly licensed nurse prepare and administer medications to assigned clients. Which of the following actions by the newly licensed nurse require immediate intervention by the charge nurse? Select all that apply.
- Connecting a secondary infusion of pantoprazole to the Y-site of a single-lumen central venous catheter infusing total parenteral nutrition (TPN).Answer
- Using a 3-mL syringe to flush a peripherally inserted central catheter (PICC) with 0.9% sodium chloride.Answer
- Programming the electronic infusion pump to deliver a 20 mEq potassium chloride intravenous piggyback over 30 minutes.Answer
- DAdministering intravenous furosemide 20 mg by pushing the medication steadily over 2 minutes.
- EPausing continuous enteral nutrition formula 1 hour before and after administering phenytoin suspension via a gastrostomy tube.
- Initiating a transfusion of packed red blood cells (PRBCs) through a peripheral intravenous line infusing 5% dextrose in water (D5W).Answer
Answer
The charge nurse must intervene on four unsafe actions: piggybacking medications into a dedicated TPN line, using a 3-mL syringe to flush a PICC, infusing potassium chloride at a dangerous rate of 40 mEq/hr, and infusing PRBCs with a dextrose solution.
The correct selections represent critical safety violations in parenteral therapy that demand immediate intervention. TPN requires a dedicated line to avoid severe incompatibilities. Flushing a central line with a small barrel syringe (like 3-mL) creates extreme pressure that can rupture the catheter. Intravenous potassium chloride must be infused slowly (max 10-20 mEq/hr); administering 20 mEq over 30 minutes results in 40 mEq/hr, which can induce cardiac arrest. Finally, blood products must only be infused with 0.9% normal saline, as dextrose solutions cause hemolysis.
Step-by-Step Solution
Key Concept
Safe Parenteral Therapy and Medication Administration Principles