A nurse is caring for an adult client who has a serum potassium level of 2.8 \text{ mEq/L}… — NCLEX-RN

A nurse is caring for an adult client who has a serum potassium level of $2.8 \text{ mEq/L}$ . The healthcare provider prescribes $40 \text{ mEq}$ of intravenous potassium chloride (KCl) diluted in $100 \text{ mL}$ of $0.9\%$ sodium chloride to be infused over $30 \text{ minutes}$ via a peripheral venous catheter. Which of the following is the priority nursing action?

Clarify the prescription with the healthcare provider because the infusion rate exceeds safe administration limits.Answer
B
Verify that the client has a urine output of at least $30 \text{ mL/hr}$ before initiating the medication.
C
Set the electronic infusion pump to deliver the medication precisely over the prescribed $30 \text{ minutes}$ .
D
Administer the medication through the Y-site of a continuous parenteral nutrition infusion.

Answer

The nurse must withhold the medication and clarify the prescription with the healthcare provider because the prescribed rate is dangerously fast.

Intravenous potassium chloride is a high-alert medication that must be administered slowly and carefully to prevent fatal cardiac arrhythmias. The maximum recommended safe infusion rate for a peripheral line is typically

10 \text{ mEq/hr}

(and generally up to

20 \text{ mEq/hr}

for a central line with continuous cardiac monitoring). The prescribed rate of

40 \text{ mEq}

over

30 \text{ minutes}

equates to an hourly rate of

80 \text{ mEq/hr}

, which is extremely dangerous and potentially lethal. The absolute priority is to withhold the medication and contact the prescribing provider to clarify and correct the prescription.

Step-by-Step Solution

Analyze the prescribed medication dose and rate parameters.

The prescription is for

40 \text{ mEq}

to be infused over

30 \text{ minutes}

, which equals an hourly rate of

80 \text{ mEq/hr}

Calculating the effective hourly rate is necessary to compare against safety guidelines for high-alert medications.

Compare the calculated rate against safe administration guidelines for intravenous potassium.

The calculated rate (

80 \text{ mEq/hr}

) far exceeds the maximum safe peripheral limit of

10 \text{ mEq/hr}

Exceeding safety limits for intravenous potassium places the client at severe risk for life-threatening cardiac arrhythmias.

Determine the priority nursing intervention.

The nurse must stop the administration process and contact the provider to intervene on the unsafe prescription.

Patient safety is the highest priority, superseding routine pre-administration assessments or carrying out orders as written.

Key Concept

Safe Administration of Intravenous Potassium

Question

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Key Concept

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