A nurse on a medical-surgical unit is caring for a client with a serum potassium level of … — NCLEX-RN

A nurse on a medical-surgical unit is caring for a client with a serum potassium level of $2.4 \text{ mEq/L}$ . The healthcare provider prescribes an intravenous infusion of $40 \text{ mEq}$ of potassium chloride in $100 \text{ mL}$ of $0.9\% \text{ sodium chloride}$ to be administered over $30 \text{ minutes}$ . The client has a patent 20-gauge peripheral intravenous catheter. Which of the following is the priority nursing action?

A
Administer the infusion as prescribed using a volumetric electronic infusion pump.
B
Assess the client's hourly urine output prior to initiating the infusion.
Contact the healthcare provider to question the prescribed infusion rate.Answer
D
Request a prescription to administer the dose via slow direct intravenous push.

Answer

Contact the healthcare provider to question the prescribed infusion rate.

The maximum safe administration rate for intravenous potassium chloride through a peripheral line is

10 \text{ mEq/hr}

(or up to

20 \text{ mEq/hr}

through a central line with continuous cardiac monitoring). The prescribed order of

40 \text{ mEq}

over

30 \text{ minutes}

equates to a rate of

80 \text{ mEq/hr}

. This rate is highly toxic and can cause immediate, fatal cardiac arrhythmias such as ventricular fibrillation. The nurse must act as a client advocate by withholding the medication and contacting the healthcare provider to request a safe infusion rate and time.

Step-by-Step Solution

Analyze the prescribed dosage and infusion time.

The prescription is for

40 \text{ mEq}

to be infused over

0.5 \text{ hours}

Determining the hourly rate is required to evaluate administration safety.

Calculate the hourly infusion rate.

The rate is

40 \text{ mEq} \div 0.5 \text{ hours} = 80 \text{ mEq/hr}

Standard safety guidelines for intravenous potassium are based on hourly maximums.

Compare the calculated rate to safe administration guidelines.

The maximum safe peripheral limit is

10 \text{ mEq/hr}

. The prescribed rate of

80 \text{ mEq/hr}

is severely unsafe.

Rapid infusion of potassium causes fatal cardiac arrhythmias.

Determine the priority nursing action.

The nurse must withhold the medication and contact the healthcare provider immediately.

Patient safety is the highest priority; the nurse must not execute a lethal medical order.

Key Concept

Safe administration of intravenous potassium chloride

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