Examkin

Question

Difficulty: MediumPharmacological and Parenteral Therapies

A client is admitted with profound hypokalemia, exhibiting a serum potassium level of 2.4 mEq/L (2.4 mmol/L). The healthcare provider prescribes an intravenous (IV) potassium replacement. The prescription reads: 'Potassium chloride 20 mEq in 100 mL of 0.9% sodium chloride IV to infuse over 30 minutes.' The client's only vascular access is a 20-gauge peripheral IV catheter in the right forearm. Which of the following is the priority nursing action?

  1. A
    Program the electronic infusion pump to deliver the solution at a rate of 200 mL/hr.
  2. Withhold the infusion and contact the healthcare provider to question the prescribed administration rate.Answer
  3. C
    Administer the infusion as prescribed while initiating continuous cardiac monitoring.
  4. D
    Administer the potassium chloride as a slow intravenous push over 5 to 10 minutes.

Answer

Withhold the infusion and contact the healthcare provider to question the prescribed administration rate.
Intravenous potassium chloride is a high-alert medication that requires strict adherence to administration protocols. The maximum safe infusion rate for a peripheral IV line is generally 10 mEq/hr. The prescribed order of 20 mEq over 30 minutes equates to a delivery rate of 40 mEq/hr, which is extremely dangerous and can cause severe chemical phlebitis, pain, or fatal cardiac arrhythmias. The nurse's priority is patient safety; therefore, the nurse must withhold this unsafe order and contact the provider to request a decreased infusion rate.

Step-by-Step Solution

1
Analyze the prescribed dosage and time parameters.
The prescription orders 20 mEq of potassium chloride over 30 minutes, which equates to an infusion rate of 40 mEq/hr.
Converting the dose to an hourly rate is necessary to compare it against established pharmacological safety guidelines.
2
Recall the safety parameters for intravenous potassium administration.
The maximum recommended safe infusion rate for potassium chloride through a peripheral IV line is 10 mEq/hr.
Rates exceeding 10 mEq/hr peripherally severely irritate the vein (causing phlebitis) and pose a high risk for life-threatening cardiac arrhythmias.
3
Evaluate the client's current venous access against the prescription.
The client only has a peripheral IV catheter, making the prescribed rate of 40 mEq/hr highly unsafe.
A central venous catheter and continuous cardiac monitoring would be required for higher rates (up to 20 mEq/hr, or rarely 40 mEq/hr in severe emergencies), but the current peripheral access cannot support this order.
4
Determine the priority nursing action based on patient safety.
The nurse must withhold the unsafe medication and immediately contact the prescribing provider.
Nurses have a legal and ethical duty to intervene when a prescription endangers a patient; an unsafe order must never be blindly executed.

Key Concept

Safe Administration of Intravenous Potassium
Estimated Time:1m 0s
Rate this question

Topics

Pharmacological and Parenteral Therapies

More questions from this topic