IV potassium chloride (KCl) 60 mEq is prescribed for a 49-year-old female patient with severe hypokalemia. Which action should the nurse take?
Infuse the KCl at a maximum rate of 10 mEq/hr.
Discontinue cardiac monitoring during the infusion.
Administer the KCl as a rapid IV bolus.
Refuse to give the KCl through a peripheral venous line.
The Correct Answer is A
Choice A: Infuse the KCl at a maximum rate of 10 mEq/hr
This is the correct answer. The recommended infusion rate for potassium chloride is generally not to exceed 10 mEq per hour to avoid complications such as hyperkalemia and cardiac arrhythmias. This rate ensures that the potassium is administered safely and effectively, allowing for proper monitoring and adjustment if necessary.
Choice B: Discontinue cardiac monitoring during the infusion
This choice is incorrect. Cardiac monitoring is essential during the infusion of potassium chloride, especially in patients with severe hypokalemia, due to the risk of arrhythmias and other cardiac complications. Continuous monitoring allows for the early detection of any adverse effects and timely intervention.
Choice C: Administer the KCl as a rapid IV bolus
Administering potassium chloride as a rapid IV bolus is dangerous and contraindicated. Rapid infusion can lead to severe hyperkalemia, which can cause fatal cardiac arrhythmias. Potassium chloride should always be administered slowly and diluted in an appropriate volume of fluid.
Choice D: Refuse to give the KCl through a peripheral venous line
While central lines are preferred for higher concentrations of potassium chloride due to the risk of irritation and phlebitis, peripheral lines can be used for lower concentrations and slower infusion rates. Refusing to administer potassium chloride through a peripheral line is not necessary if the infusion is properly managed and monitored.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A: True
Neutropenia, characterized by a low count of neutrophils (a type of white blood cell), significantly increases a patient’s risk for life-threatening infections and sepsis. Neutrophils play a crucial role in the immune system by fighting off infections. When their levels are low, the body becomes more susceptible to infections, which can quickly escalate to sepsis if not promptly treated. Neutropenic sepsis is a severe and potentially fatal condition that requires immediate medical intervention. Patients undergoing treatments like chemotherapy are particularly at risk due to their compromised immune systems.
Choice B: False
The statement that neutropenia does not increase the risk for life-threatening infection and sepsis is incorrect. Neutropenia is well-documented as a major risk factor for severe infections and sepsis. Without adequate neutrophils, the body’s ability to combat pathogens is severely impaired, leading to a higher likelihood of infections that can become systemic and life-threatening. Therefore, it is critical to monitor and manage neutropenic patients closely to prevent and treat infections promptly.
Correct Answer is ["A","B","C","D"]
Explanation
Choice A: Anesthetic agents and other drugs that were administered
This is a correct answer. Including information about the anesthetic agents and other drugs administered during surgery is crucial for the PACU nurse. This information helps in monitoring the patient’s recovery from anesthesia and managing any potential side effects or complications. Knowing the specific drugs used allows the PACU nurse to anticipate and address issues such as pain management, nausea, and allergic reactions.
Choice B: The patient’s relevant health history
This is another correct answer. The patient’s relevant health history provides essential context for the PACU nurse. It includes information about chronic conditions, allergies, previous surgeries, and any other factors that might affect the patient’s recovery. Understanding the patient’s health history helps the PACU nurse to tailor post-operative care to the patient’s specific needs and to be vigilant for any complications that might arise due to pre-existing conditions.
Choice C: The name of the surgical procedure
This is also a correct answer. Knowing the specific surgical procedure performed is vital for the PACU nurse. It helps in understanding the expected post-operative course, potential complications, and specific care requirements. For example, the care for a patient who underwent a cardiac surgery will differ significantly from the care for a patient who had an orthopedic procedure.
Choice D: Estimated blood loss during surgery
This is the final correct answer. Reporting the estimated blood loss during surgery is important for the PACU nurse to assess the patient’s hemodynamic status and to plan for any necessary interventions. Significant blood loss may require monitoring for signs of hypovolemia, administering fluids or blood products, and closely watching vital signs.
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