# A nurse is preparing to administer IV lorazepam 2 mg for an acute alcohol withdrawal seizure. Which action best ensures safe administration?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391722&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A nurse is preparing to administer IV lorazepam 2 mg for an acute alcohol withdrawal seizure. Which action best ensures safe administration?

## Option

1. Dilute the dose in 100 mL normal saline and infuse over 30 minutes.
2. Give the dose intramuscularly if the IV access seems sluggish.
3. Push the dose slowly over at least 2 minutes while monitoring respirations. **✔ Correct answer**
4. Have flumazenil drawn up at the bedside before pushing the dose.

**Correct answer: 3**

## Explanation

Correct (2): IV lorazepam is a high-alert benzodiazepine. It must be pushed slowly at no more than 2 mg/min (≥2 minutes for this dose) while continuously monitoring respiratory rate and SpO2. Respiratory depression is the most common life-threatening adverse effect. (1) Incorrect — flumazenil is not given prophylactically; it is reserved for confirmed iatrogenic overdose, and routine bedside priming can encourage inappropriate reversal in chronic users. (3) Incorrect — dilution and 30-minute infusion describes a continuous drip, not the bolus used to abort a seizure. (4) Incorrect — IM absorption is erratic; IV is the route of choice for an active seizure.

## In-depth explanation

Memory Tip "Lorazepam IV: 2 minutes, 2 mg" — the rule of two 2s. Caution Flumazenil reverses benzo respiratory depression but is NOT prophylactic; it can precipitate withdrawal seizures in chronic benzodiazepine users. Clinical Practice Guide Reassess RR and SpO2 at 5, 10, and 15 minutes post-administration; have airway support equipment at the bedside.

## Clinical scenario

Scenario A 56-year-old male was admitted 48 hours ago for alcohol use disorder withdrawal. CIWA-Ar 28 and a 90-second generalized tonic-clonic seizure just occurred. The provider orders lorazepam 2 mg IV push now. The client has a patent 20-gauge peripheral IV in the left forearm and pulse oximetry of 96% on room air.

## Key concepts

- **High-alert medication (HAM)** — A medication bearing heightened risk of significant patient harm when used in error; IV benzodiazepines are on the ISMP high-alert list and require independent double-checks and slow administration.
- **Pasero Opioid-induced Sedation Scale (POSS)** — A 5-level scale used to monitor sedation during sedative or opioid administration; a score >3 indicates the need to hold further dosing and consider reversal.
- **Flumazenil** — A benzodiazepine antagonist used to reverse iatrogenic respiratory depression; not given prophylactically because it can precipitate seizures in chronic benzodiazepine users.

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