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Difficulty: MediumPharmacological and Parenteral Therapies

A nurse is planning care for a client who has a serum potassium level of 2.6 mEq/L2.6\text{ mEq/L} and a prescription for intravenous potassium chloride (KCl) replacement. Which of the following nursing actions are required for the safe administration of this medication? (Select all that apply.)

  1. Verify that the client's urine output is at least 30 mL/hr30\text{ mL/hr} before initiating the infusion.Answer
  2. Ensure the medication is administered using an electronic volumetric infusion pump.Answer
  3. C
    Administer the prescribed dose as a slow, direct intravenous push over 5 minutes.
  4. D
    Program the pump to deliver 20 mEq/hr20\text{ mEq/hr} through a standard peripheral intravenous catheter.
  5. Assess the intravenous insertion site hourly for signs of phlebitis or extravasation.Answer
  6. F
    Inject the concentrated medication directly into the injection port of a hanging, actively infusing fluid bag.

Answer

The correct actions are verifying a urine output of at least 30 mL/hr30\text{ mL/hr}, using an electronic infusion pump, and assessing the IV site hourly.
Potassium chloride is a high-alert medication that requires rigorous safety protocols. The correct actions ensure the patient has adequate renal clearance (urine output of at least 30 mL/hr30\text{ mL/hr}) to prevent hyperkalemia, utilize an electronic volumetric pump to strictly regulate the infusion rate, and mandate frequent assessment of the peripheral IV site because the medication is a known vesicant and severe vascular irritant.

Step-by-Step Solution

1
Analyze the prescribed medication and its risk profile.
Potassium chloride is a high-alert medication that can cause lethal arrhythmias and severe tissue necrosis if administered improperly.
Recognizing the high-risk nature of the drug dictates the necessary safety precautions.
2
Evaluate the requirement for an electronic infusion pump and site monitoring.
The infusion must be strictly controlled with a pump to prevent rapid administration, and the peripheral site must be assessed hourly because potassium is highly irritating to veins.
These actions prevent accidental boluses and severe chemical phlebitis or extravasation.
3
Assess physiological prerequisites for potassium administration.
Renal function must be verified (urine output ≥30 mL/hr\geq 30\text{ mL/hr}) because the kidneys excrete the majority of potassium.
Administering potassium to a client with renal impairment can quickly lead to life-threatening hyperkalemia.
4
Identify contraindicated actions that compromise patient safety.
Direct IV push, rapid peripheral infusion rates (20 mEq/hr20\text{ mEq/hr}), and adding concentrated electrolytes to actively infusing bags are critical safety violations.
These actions lead to immediate cardiac arrest or massive medication errors.

Key Concept

Safe Parenteral Administration of Potassium Chloride
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Topics

Pharmacological and Parenteral Therapies

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