# A nurse receives a phone call from the laboratory: a postoperative patient's potassium is 6.4 mEq/L (critical high). Which is the nurse's priority action per The Joint Commission National Patient Safety Goal NPSG.02.03.01?

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> subject: NCLEX-RN  
> category: SIPC

## Question

A nurse receives a phone call from the laboratory: a postoperative patient's potassium is 6.4 mEq/L (critical high). Which is the nurse's priority action per The Joint Commission National Patient Safety Goal NPSG.02.03.01?

## Option

1. Document the value in the chart and follow up at the next provider rounds in 4 hours.
2. Read back the value to the laboratory technician for verification, then notify the responsible provider as soon as possible and document the timing of notification and read-back. **✔ Correct answer**
3. Repeat the lab to confirm before notifying the provider, since hemolysis is the most common cause of an isolated high potassium.
4. Tell the patient about the result before notifying the provider so the patient is aware.

**Correct answer: 2**

## Explanation

NPSG.02.03.01 (Improving the timeliness of reporting critical results) requires that critical results be reported as soon as possible, that the receiver use a read-back/repeat-back to verify accuracy, and that the timing of the receipt and provider notification be documented. The nurse must read the value back to the laboratory technician (closing the communication loop), notify the responsible provider immediately, and document both the read-back and the time of notification. Choice 1 delays action on a life-threatening value (potassium 6.4 risks dysrhythmia). Choice 3 delays notification — repeat is appropriate when hemolysis is suspected, but only after notifying the provider, who decides whether to repeat or treat empirically. Choice 4 reverses the priority and is not the standard.

## In-depth explanation

NPSG.02.03.01 is the Joint Commission goal of improving the timeliness of reporting critical test and diagnostic results. It requires a defined critical-value list, defined reporting-time expectations, read-back or repeat-back by the receiver, and documentation of timing of receipt and notification. Read-back/repeat-back is the closed-loop communication used for verbal and telephone reports of critical values, telephone orders, and verbal orders: the receiver reads or repeats the value back to the sender, and the sender confirms accuracy. This reduces transcription and hearing errors. Examples of common adult critical lows and highs (lab-specific) include glucose under 40 or over 500, potassium under 2.8 or over 6.0, sodium under 120 or over 160, hemoglobin under 7, platelets under 50K, WBC under 1K, elevated troponin, and INR over 5 with bleeding risk. Each laboratory publishes its own list and required notification times.

## Clinical scenario

A nurse receives a phone call from the laboratory: a **postoperative patient's potassium is 6.4 mEq/L** (critical high). Per **NPSG.02.03.01**, the nurse must act on the critical result.

## Key concepts

- **NPSG.02.03.01** — The Joint Commission goal: improve the timeliness of reporting critical test and diagnostic results. Requires defined critical-value list, defined reporting-time expectations, read-back/repeat-back by the receiver, and documentation of timing of receipt and notification.
- **Read-Back / Repeat-Back** — Closed-loop communication for verbal and telephone reports of critical values. The receiver reads or repeats the value back to the sender, who confirms accuracy. Required for critical results, telephone orders, and verbal orders. Reduces transcription and hearing errors.
- **Critical Value Examples** — Common adult critical lows/highs (lab-specific): glucose 500, K 6.0, Na 160, Hb

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