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Difficulty: MediumPharmacological and Parenteral Therapies

A nurse is reviewing medication orders for a client admitted with hypokalemia. The healthcare provider has prescribed 40 mEq of intravenous (IV) potassium chloride (KCl) mixed in 100 mL of 0.9% sodium chloride to be infused over 1 hour via a peripheral IV catheter. Which of the following is the priority nursing action?

  1. Contact the healthcare provider to clarify the medication prescription.Answer
  2. B
    Initiate the infusion using an electronic IV pump to ensure an accurate rate.
  3. C
    Verify that the client's urine output is at least 30 mL/hr before starting the infusion.
  4. D
    Place the client on continuous cardiac monitoring while the medication is infusing.

Answer

Contact the healthcare provider to clarify the medication prescription.
The prescribed rate of 40 mEq/hr for IV potassium chloride is intrinsically unsafe. The maximum safe infusion rate for potassium chloride via a peripheral IV line is typically 10 mEq/hr. Rates exceeding this can cause severe phlebitis, tissue necrosis, and life-threatening cardiac arrhythmias. The nurse must contact the healthcare provider to clarify and change the prescription before taking any other action.

Step-by-Step Solution

1
Identify the prescribed medication, dose, route, and rate.
The prescription is for 40 mEq of IV potassium chloride over 1 hour via a peripheral IV.
Understanding the exact parameters of the medication order is the first step in ensuring patient safety.
2
Recall the safe administration guidelines for IV potassium chloride.
The maximum recommended rate for a peripheral IV is typically 10 mEq/hr. Faster rates or higher concentrations risk severe phlebitis and life-threatening cardiac arrhythmias.
Nurses are responsible for verifying that prescribed dosages and rates fall within safe parameters before administration.
3
Compare the prescribed rate to the safe maximum rate.
The prescribed rate of 40 mEq/hr is four times the safe peripheral limit.
Comparing the order to safety standards identifies potential medication errors.
4
Determine the priority nursing action based on the identified risk.
The nurse must withhold the medication and contact the healthcare provider to clarify and change the prescription.
Patient safety is the highest priority, and nurses must not carry out unsafe medication orders.

Key Concept

Intravenous Potassium Administration Safety
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Topics

Pharmacological and Parenteral Therapies

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