# A client has a prescription for intravenous potassium replacement. For each proposed action, identify whether it is appropriate or unsafe.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=546629&lang=en  
> language: en  
> subject: Parenteral/IV Therapies  
> category: PPT

## Question

A client has a prescription for intravenous potassium replacement. For each proposed action, identify whether it is appropriate or unsafe.

|  | Appropriate | Unsafe |
| --- | --- | --- |
| Confirm the current potassium value, renal function, and urine output |  |  |
| Administer concentrated potassium chloride by intravenous push |  |  |
| Use a properly diluted solution and calibrated infusion device at the prescribed rate |  |  |
| Inject potassium concentrate directly into a hanging bedside bag |  |  |
| Verify line patency and monitor the site and cardiac rhythm as indicated |  |  |
| Continue the infusion despite new burning, swelling, and loss of blood return |  |  |

## Explanation

Concentrated potassium chloride can be fatal if given by direct injection. The nurse verifies the current potassium level, renal function and urine output, prescription, dilution, access, and monitoring plan. The prepared diluted solution is administered at the prescribed controlled rate using a calibrated infusion device. The nurse verifies line patency and monitors the site and cardiac rhythm as indicated. Concentrate is not injected intravenously, added casually to a hanging container, or continued through a painful swollen site.

## In-depth explanation

Correct Answer
Use verified assessment, dilution, a calibrated device, and close monitoring; never give IV push or add concentrate unsafely.

Why It Fits
Rapid or concentrated potassium delivery can cause sudden fatal hyperkalemia and arrhythmia, while impaired renal excretion increases accumulation risk.

Clinical Picture
Peripheral pain or swelling may indicate phlebitis or infiltration and requires stopping and reassessing the site.

Memory Link
Potassium is diluted, pumped, and watched—never pushed.

NCLEX Rule
Intravenous potassium is administered only as a properly diluted, controlled infusion after confirming patient and access safety.

Why the Alternatives Fail
IV push, bedside concentrate addition, ignoring renal status, or continuing through a compromised site creates immediate preventable harm.

Sources
1DailyMed Potassium Chloride Injection Concentrate
2FDA Potassium Chloride Concentrate Label
3NCSBN 2026 NCLEX-RN Test Plan

## Clinical scenario

Telemetry unit
The client's potassium is 2.8 mEq/L after prolonged gastrointestinal losses. Renal function, current urine output, vascular access, the prescribed concentration and rate, and cardiac rhythm must be considered before and during replacement.

## Key concepts

- **Calibrated infusion device** — A pump or controller that delivers intravenous fluid at a measured prescribed rate.
- **Potassium intoxication** — Dangerous potassium excess that can cause conduction abnormalities and fatal arrhythmias.
- **Extravasation** — Leakage of an irritating intravenous solution into surrounding tissue.

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