As a safety alert the nurse is aware the following medication is never given directly intravenously?

OSSSC Nursing Officer-2023

Pharmacology

Easy

Appeared in: OSSSC Nursing Officer-2023

Explanation

Potassium chloride (KCl) is never administered as a direct intravenous (IV) push or bolus.
Injecting undiluted KCl directly into a vein causes an immediate, sharp increase in serum potassium levels (hyperkalemia).
This sudden hyperkalemia disrupts the heart's electrical conduction, leading to severe cardiac dysrhythmias and fatal cardiac arrest.
For safety, KCl must always be diluted in a compatible IV fluid and administered as a slow, controlled infusion using a pump.
Due to this high risk, it is classified as a high-alert medication requiring special precautions, such as independent double checks.

Option B: Lasix (furosemide) can be administered via IV push.
Option C: Dextrose, particularly concentrated solutions like 50% Dextrose in Water (D50W), is commonly given as a rapid IV push.
Option D: Calcium gluconate is administered intravenously, often as a slow IV push or infusion.

Visual 1: Infographic - A 'High-Alert Medications' safety poster, prominently featuring a 'Do Not Push' symbol over a vial of Potassium Chloride.
Visual 2: Diagram - A side-by-side comparison showing the incorrect method (a syringe pushing directly into an IV port) versus the correct method (a diluted IV piggyback bag connected to an infusion pump) for potassium administration.

Clinical Relevance

Nursing practice connection: Knowing Safe administration of intravenous medications, specifically high-alert drugs helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
This is a critical patient safety rule that every nurse must know. An error with IV potassium administration is a 'never event' and can be lethal.
Nurses must adhere to the 'Five Rights' of medication administration and institutional policies for high-alert drugs, which often include independent double-checks by two nurses before administration.
Always question an order for 'IV push potassium'. Clarify with the prescriber and pharmacy immediately, as the order is unsafe.

How to Approach the Question

First, identify the core question: Which medication has an absolute contraindication for direct IV administration?
The keyword 'never' signifies an absolute rule, not a guideline or a recommendation for a specific situation.
Review each medication option and recall its standard IV administration method and associated safety warnings.
Recall that Potassium Chloride is a well-known high-alert medication with a black box warning against IV push due to the risk of cardiac arrest.
Compare this absolute prohibition with the other options. Lasix, Dextrose, and Calcium Gluconate are all given IV, but without the same 'never push' rule.
Select the option that matches the absolute contraindication described in the question.

Concept Tested & Keywords

Concept Tested: Safe administration of intravenous medications, specifically high-alert drugs.
Stem keywords: safety alert, medication, never given directly intravenously
Lead-in keywords: never
Negative lead-in flag: false

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