# 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?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=373128&lang=en  
> language: en  
> subject: NCLEX-RN  
> category: 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?

## Option

1. Administer IV push 40 mEq over 2 minutes through the peripheral line.
2. Use an infusion pump to deliver no more than 10 mEq/hr through a peripheral line, or up to 20 mEq/hr through a central line; never IV push. **✔ Correct answer**
3. Add 40 mEq to a 50 mL syringe of normal saline and infuse over 30 minutes via syringe pump.
4. Mix the potassium with insulin and dextrose to drive it intracellularly faster.

**Correct answer: 2**

## 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

- **IV potassium chloride** — High-alert electrolyte replacement; fatal in IV push, must be infused diluted via pump.
- **Peripheral vs central infusion limit** — Peripheral up to 10 mEq/hr (limited by phlebitis); central up to 20 mEq/hr with cardiac monitoring.
- **ISMP "do not use" — IV push potassium** — Listed by ISMP as never-events; bedside and pharmacy double-check policies enforce premixed bag-only delivery.

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