A patient has a serum potassium of 2.8 mEq/L and a new order… | MyMerci
NCLEX-RN PPT
Question

A patient has a serum potassium of 2.8 mEq/L and a new order for IV potassium chloride 40 mEq. Which nursing action reflects safe IV potassium administration?

Explanation
IV potassium chloride is a HIGH-ALERT medication. NEVER give IV push — IV push potassium causes fatal arrhythmias and is the classic ISMP "do not use" practice. Standard limits: peripheral up to 10 mEq/hr (causes phlebitis at higher rates), central up to 20 mEq/hr (or higher in critical care with continuous monitoring), always via infusion pump, always diluted in a premixed bag (never as a syringe push), continuous cardiac monitoring for severe deficits, and reassessment of K+ after the dose.

In-depth explanation

IV push potassium = fatal — this is the most-tested NCLEX medication safety scenario after insulin and heparin. ISMP and Joint Commission have repeatedly cited IV push KCl as a sentinel-event-causing practice. Premixed bags only, infusion pump only, never the syringe.

Clinical scenario

Adult patient on a med-surg unit with serum K+ 2.8 mEq/L. New order: IV potassium chloride 40 mEq. Patient has a peripheral 18-gauge IV in the right forearm.

Key concepts

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For study reference only. Always follow current clinical guidelines and your institution’s protocols.