The nurse prepares a prescribed dose of potassium chloride concentrate for a client with hypokalemia. Which action is appropriate?
1Dilute and mix it completely, infuse it with a pump at the prescribed rate, and monitor the client.✓ Correct answer
2Administer the concentrate by slow IV push while observing the cardiac rhythm.
3Inject the concentrate into a hanging IV bag and begin the infusion without mixing it.
4Use a rapid infusion rate based only on the dose without reviewing potassium or renal function.
Explanation
Potassium chloride concentrate is administered only after dilution in a larger volume of compatible IV fluid and complete mixing. It is infused with a pump at a rate selected for the client's potassium level and clinical condition. Serum potassium, renal function, IV-site status, and cardiac risk require monitoring. Undiluted IV administration can cause fatal arrhythmia or cardiac arrest, and concentrated solution must never be given by IV push.
Clinical reasoning Potassium directly alters cardiac membrane excitability. A concentrated bolus or poorly mixed solution can abruptly expose the heart to a lethal potassium load.
Decision rule Verify dilution and complete mixing, use an infusion pump, follow the patient-specific prescribed rate, and intensify cardiac and laboratory monitoring as concentration, rate, and clinical severity increase.
Scenario 60-year-old male with hypokalemia (K+ 2.8 mEq/L), no arrhythmia, urine output 50 mL/hr. KCl 40 mEq IV ordered.
IV potassium chloride — A high-alert electrolyte replacement that must be diluted and administered by controlled intravenous infusion, never by IV push.
Potassium infusion monitoring — Safety assessment includes serum potassium, renal function, infusion-site patency, pump settings, and cardiac monitoring when clinically indicated.
KCl infiltration — Burning sign; reduce rate or change site to larger vein; never push.