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Difficulty: HardPharmacological and Parenteral Therapies

A nurse is preparing to administer intravenous (IV) potassium chloride (KCl) 40 mEq40\text{ mEq} in 250 mL250\text{ mL} of 0.9%0.9\% sodium chloride to a client with a serum potassium level of 2.6 mEq/L2.6\text{ mEq/L}. The client is currently receiving a continuous IV infusion of pantoprazole through a single peripheral IV line. Which of the following actions by the nurse are appropriate? Select all that apply.

  1. Verify that the client's urine output has been at least 30 mL/hr30\text{ mL/hr} before initiating the infusion.Answer
  2. B
    Administer the medication as an undiluted IV push over 33 to 5 minutes5\text{ minutes} to quickly stabilize the cardiac rhythm.
  3. Assess the peripheral IV insertion site for signs of phlebitis or infiltration hourly during the infusion.Answer
  4. D
    Program the electronic infusion pump to deliver the potassium chloride at a rate of 40 mEq/hr40\text{ mEq/hr}.
  5. Check a drug reference guide to confirm the compatibility of potassium chloride with pantoprazole at the Y-site.Answer
  6. F
    Temporarily stop the pantoprazole, manually flush the line with 3 mL3\text{ mL} of sterile water, and connect the potassium infusion.

Answer

The appropriate actions are verifying adequate urine output, assessing the IV site hourly for infiltration, and checking Y-site compatibility with the concurrent pantoprazole infusion.
Safe administration of intravenous potassium chloride requires confirming adequate renal function (urine output >30 mL/hr> 30\text{ mL/hr}) to prevent accumulation, meticulously assessing the peripheral IV site due to the drug's vesicant properties, and verifying Y-site compatibility with any continuous infusions to prevent dangerous crystallization in the tubing.

Step-by-Step Solution

1
Evaluate the prescribed medication (potassium chloride) for strict safety parameters and administration routes.
Identify that potassium chloride must be diluted, infused slowly via a pump (max 10 mEq/hr10\text{ mEq/hr} peripherally), and never given IV push.
Rapid administration of potassium causes fatal cardiac dysrhythmias.
2
Assess the client's physiological readiness to receive the medication.
Determine that urine output must be at least 30 mL/hr30\text{ mL/hr}.
Potassium is primarily excreted by the kidneys; oliguria or anuria can lead to toxic accumulation.
3
Analyze the method of delivery and concurrently infusing medications.
Identify that Y-site compatibility with pantoprazole must be verified, and the peripheral site must be monitored hourly.
Mixing incompatible drugs causes precipitation, and potassium is a vesicant that can cause severe tissue necrosis if it infiltrates.

Key Concept

High-alert parenteral medication safety principles, specifically focusing on intravenous potassium administration, compatibility, and organ function assessment.
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Topics

Pharmacological and Parenteral Therapies

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