The nurse must ensure safe administration to prevent complications such as cardiac arrhythmias or tissue necrosis. Which of the following statements is correct regarding potassium chloride injection?

1. A

   Should be administered by IV bolus

2. B

   Should be dissolved in 0.9% Normal Saline (NS) and given via infusion pump

3. C

   Should be administered by intramuscular (IM) route

4. D

   Should be dissolved in dextrose solution

Appeared in: NORCET 6 mains-2024

Explanation

Listen in Hindi

• Potassium chloride (KCl) is a high-alert medication that must be diluted in a compatible IV fluid, such as 0.9% Normal Saline, to prevent vein irritation and systemic toxicity.
• Administration must be performed using an infusion pump to ensure a slow, controlled rate (typically not exceeding 10 mEq/hr in unmonitored patients) to prevent fatal cardiac arrhythmias.
• Using Normal Saline is preferred over dextrose solutions because dextrose stimulates insulin release, which can cause a temporary, counterproductive shift of potassium into the cells, worsening hypokalemia.

Why Other Options Were Wrong

• Option A: Administering KCl as an IV push or bolus causes a sudden, lethal spike in serum potassium levels, which can lead to immediate cardiac arrest.
• Option C: KCl is an extreme tissue irritant. Injecting it intramuscularly would cause severe pain, inflammation, and likely lead to sterile abscess formation and tissue necrosis.
• Option D: Dextrose stimulates insulin secretion, which promotes the uptake of potassium into cells. This effect can paradoxically lower serum potassium levels, which is counterproductive when treating hypokalemia.

Related Visual

Clinical Relevance

• Nursing practice connection: Knowing Safe administration of intravenous potassium chloride (KCl) helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
• Potassium chloride is a high-alert medication. Many healthcare facilities mandate an independent double-check by two registered nurses before administration to prevent catastrophic errors.
• Always assess the IV site frequently for signs of phlebitis or infiltration. If infiltration occurs, stop the infusion immediately, as extravasation of KCl (a vesicant) can cause tissue necrosis.
• Remember the critical safety mnemonic 'No Pee, No K'. Always confirm adequate renal function (urine output of at least 30 mL/hr for an adult) before and during potassium administration, as the kidneys are the primary route of excretion.

How to Approach the Question

• First, identify the question as a medication safety and procedure problem concerning a high-alert drug (Potassium Chloride).
• Recall the absolute contraindications and cardinal rules for KCl administration. IV push/bolus and IM injection are always incorrect due to severe, life-threatening risks. This immediately eliminates options A and C.
• Next, differentiate between the two remaining IV infusion options (B and D) by considering the diluent.
• Analyze the physiological effect of each diluent. Dextrose stimulates insulin, which moves potassium into cells. This is the opposite of the desired effect when treating low potassium (hypokalemia). Normal Saline is an isotonic solution that does not have this effect.
• Conclude that diluting in Normal Saline and administering via an infusion pump is the safest, most effective, and standard method for IV potassium replacement.

Concept Tested & Keywords

• Concept Tested: Safe administration of intravenous potassium chloride (KCl)
• Stem keywords: potassium chloride injection, safe administration, cardiac arrhythmias, tissue necrosis
• Lead-in keywords: correct regarding
• Negative lead-in flag: false

Question ID

QCq89xZr7H8Q5iSp64TPiJ

Copy ID

Reference Book

E6 Pharmacology Nursing Lilley 11e Part 2 pp. 171-173, 165-167

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 1 p. 151-153