NCLEX · Fluid and Electrolyte Imbalances

A client receiving IV potassium chloride (KCl) reports burning at the IV site. What should the nurse do first?

Correct answer

Slow or stop the infusion and assess the site — KCl is irritating to veins; burning may indicate the rate is too fast or infiltration; KCl is NEVER given IV push (causes fatal cardiac arrest) and must be diluted and infused slowly via pump

  1. A Increase the infusion rate to flush it through faster
  2. B Slow or stop the infusion and assess the site — KCl is irritating to veins; burning may indicate the rate is too fast or infiltration; KCl is NEVER given IV push (causes fatal cardiac arrest) and must be diluted and infused slowly via pump
  3. C Apply heat to the site
  4. D Document and continue the infusion

Why this is the answer

IV POTASSIUM SAFETY — A HIGH-ALERT MEDICATION: KCl is irritating to veins and dangerous if administered incorrectly. BURNING at the site: Slow or stop the infusion; assess for infiltration; KCl is a vein irritant — slower rates and greater dilution reduce burning; consider a central line for higher concentrations; NEVER IV PUSH: Concentrated IV potassium push causes immediate fatal cardiac arrest (cardioplegia) — KCl must ALWAYS be diluted and infused slowly; ADMINISTRATION RULES: Maximum peripheral concentration and rate per protocol (typically not exceeding 10 mEq/hour peripherally without cardiac monitoring); always use an infusion pump; never bolus; CARDIAC MONITORING: For higher rates or concentrations; HYPERKALEMIA RISK: Too much/too fast potassium causes hyperkalemia → peaked T waves, widened QRS, fatal dysrhythmias; ASSESS renal function before administration (impaired kidneys can't excrete potassium); LPN role: monitor IV site, infusion rate, never administer KCl IV push, report burning or cardiac symptoms.
Source: NCLEX-PN Physiological — Fluid/Electrolytes, IV Potassium Safety