A nurse is preparing to administer prescribed intravenous (IV) potassium replacement to a client who has a potassium level of 2.5 mEq/L due to furosemide use. Which actions should the nurse incorporate into the plan of care? Select all that apply

A. Severe hypokalemia significantly alters the resting membrane potential of myocardial cells, increasing the risk of lethal ventricular dysrhythmias. Continuous electrocardiographic monitoring is essential during intravenous replacement to detect premature ventricular contractions or heart block. This allows the nurse to intervene immediately if the infusion rate causes rapid shifts in cardiac electrical conduction.

B. Furosemide is a loop diuretic that causes significant renal potassium wasting by inhibiting the sodium-potassium-chloride cotransporter. Providing education on potassium-rich dietary sources helps the client maintain electrolyte homeostasis and prevents future episodes of profound deficiency. Nutritional management is a key component of long-term therapy for patients requiring chronic diuretic use for fluid volume management.

C. Drawing serum potassium levels immediately after an infusion provides an inaccurate reflection of the total body potassium stores due to incomplete equilibration. Potassium is primarily an intracellular cation, and premature testing only measures the transiently high intravascular concentration. Protocols typically require waiting several hours after the infusion ends to ensure the laboratory results reflect a true systemic steady state.

D. Preparing potassium infusions solely with 5% dextrose can be counterproductive because glucose stimulates insulin release, which shifts potassium from the extracellular fluid into the cells. This intracellular shift can actually lower the serum potassium level further during the initial phase of administration. Saline-based solutions are often preferred to ensure that the administered potassium remains in the vascular space to correct the deficit.

E. Potassium is primarily excreted by the kidneys, and administration in the presence of oliguria or renal failure can lead to rapid, life-threatening hyperkalemia. Verifying adequate renal function, defined as an output of at least 0.5 to 1 mL/kg/hour, ensures the body can safely process and excrete the supplemental mineral. This nursing action is a critical safety barrier against the development of iatrogenic potassium toxicity.