A nurse is preparing to administer an intravenous infusion of amphotericin B deoxycholate … — NCLEX-RN

A nurse is preparing to administer an intravenous infusion of amphotericin B deoxycholate to a client with a severe systemic fungal infection. Upon reviewing the client's medical record, laboratory results, and the medication preparation, which of the following findings requires the nurse to withhold the infusion and contact the healthcare provider?

The client's most recent serum potassium level is $3.1 \text{ mEq/L}$ ( $3.1 \text{ mmol/L}$ ).Answer
B
The pharmacy prepared the medication diluted in $500 \text{ mL}$ of $5\%$ dextrose in water (D5W).
C
The client received prescribed oral acetaminophen and diphenhydramine $30 \text{ minutes}$ ago.
D
The infusion pump is programmed to deliver the total volume of $500 \text{ mL}$ at a rate of $125 \text{ mL/hr}$ .

Answer

The most recent serum potassium level of

3.1 \text{ mEq/L}

requires the nurse to withhold the infusion.

The correct answer is the potassium level of

3.1 \text{ mEq/L}

. Amphotericin B is a high-alert medication known for its significant nephrotoxicity, which often leads to severe renal wasting of potassium and magnesium. A normal serum potassium level is

3.5

5.0 \text{ mEq/L}

. Administering this medication to a client who already has hypokalemia could result in a critical, life-threatening exacerbation of the electrolyte imbalance, potentially leading to fatal cardiac dysrhythmias. The provider must prescribe potassium replacement therapy before the infusion can safely begin.

Step-by-Step Solution

Analyze the potential adverse effects of amphotericin B deoxycholate.

Identify that amphotericin B is highly nephrotoxic and commonly causes severe hypokalemia and hypomagnesemia.

Understanding the drug's toxicity profile is necessary to evaluate the safety of the client's baseline laboratory values.

Evaluate the client's current serum potassium level.

Determine that

3.1 \text{ mEq/L}

is below the normal range of

3.5

5.0 \text{ mEq/L}

Identifying pre-existing hypokalemia is critical because administering a potassium-depleting medication will worsen the deficit.

Determine the necessary nursing intervention based on the findings.

Conclude that the infusion must be withheld and the provider notified to correct the potassium level prior to administration.

Proceeding with the infusion could precipitate severe or fatal cardiac dysrhythmias.

Key Concept

Prioritizing patient safety by recognizing contraindications and severe adverse effects of high-risk intravenous medications.

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