NCLEX-RN Exam Preparation: Potassium Chloride Medication Calculations with Nurse Brennan

Medliant International Healthcare Staffing is here to support you every step of the way in your journey to successfully immigrate to the USA as a Registered Nurse. I am Nurse Brennan, an international Registered Nurse from Canada who immigrated to the USA in 2019. I have worked as an NCLEX author, instructor, and content writer and I will be creating practice exams similar to this one to help you prepare for the NCLEX-RN Exam itself.

And remember that Medliant will reimburse the cost of your NCLEX-RN exam once you start working in the USA! This is just one of the many benefits of choosing Medliant to sponsor you on a Green Card Visa to help you achieve your American Dream and begin working as a Registered Nurse in the USA!

Practice Questions

Use the following scenario to answer questions 1-3:

A 40 year old adult patient who weighs 94 kg is prescribed a one time dose of IV potassium chloride for a serum blood potassium level of 2.8 mEq/L that was drawn this morning. The physicians order states to administer 35 mEq of potassium chloride over 2 hours IV in normal saline via the patients PICC line. Pharmacy delivers a 1000ml bag of normal saline with 40 mEq/L of potassium chloride to the unit to be administered to this patient. Note: The maximum safe infusion rate for potassium chloride is 0.5 mEq/kg/hr with a maximum of 30 mEq/hr. The maximum safe concentration for potassium chloride if given via a central line is 0.4 mEq/ml for intermittent infusions.

1. Is the order rate and concentration safe to administer?

a)     The rate is safe and the concentration is safe; you can administer this medication

b)    The rate is safe and the concentration is not safe; do not administer this medication

c)     The rate is not safe and the concentration is not safe; do not administer this medication

d)     The rate is not safe and the concentration is not safe; do not administer this medication

2. Which of the following is the correct amount of the 1000ml bag of normal saline with 40 mEq/L of potassium chloride bag to administer for this order?

a)    400 ml

b)    438 ml

c)    875 ml

d)    1000 ml

3. Which of the following is the correct rate that you would administer this infusion at (round to the nearest whole number)?

a)    400 ml/hr

b)    438 ml/hr

c)     875 ml/hr

d)    1000 ml/hr

Answers and Rationale

1. Is the order rate and concentration safe to administer?

a)     The rate is safe and the concentration is safe; you can administer this medication

b)    The rate is safe and the concentration is not safe; do not administer this medication

c)     The rate is not safe and the concentration is not safe; do not administer this medication

d)     The rate is not safe and the concentration is not safe; do not administer this medication

The correct answer is A, the rate is safe and the concentration is safe; you can administer this medication. If you are administering 35 mEq of potassium chloride over 2 hours you would divide 35 mEq by 2 hours, which would = 17.5 mEq of potassium chloride/hr. The maximum safe rate is 30 mEq/hr which is safe, however we need to determine that it is also safe for the patients weight, thus we will multiple 94kg into 0.5 mEq/kg/hr, which = 47 mEq/hr. 17.5 mEq of potassium chloride/hr is less than the lowest maximum safe rate, thus the rate of this order is safe for this patient (note: you would also use the lower rate as the maximum safe rate). As for the concentration, we know that the bag we are using to administer is 40 mEq/L of potassium chloride and the maximum safe concentration for potassium chloride when given via a central line is 0.4 mEq/ml. If we convert this max safe concentration from ml to L by multiplying 0.4 mEq/ml x 1000 ml/1L it converts to 400 mEq/L, thus the concentration we are using is also safe. The order has a safe rate and safe concentration, thus it can be administered

2. How much of the 1000ml bag of normal saline with 40 mEq/L of potassium chloride bag would you administer for this order?

a)    400 ml

b)    438 ml

c)    875 ml

d)    1000 ml

The correct answer is C, you would administer 875 ml of the bag. To determine the appropriate amount of medication to administer you would first divide what you want (35 mEq/L) by what you have (40 mEq/L) x the volume in ml (1L = 1000 ml). 35 mEq/L divided by 40 mEq/L = 0.875 and multiplied by 1000 ml = 875 ml.

3. Which of the following is the correct rate that you would administer this infusion at (round to the nearest whole number)?

a)    400 ml/hr

b)    438 ml/hr

c)     875 ml/hr

d)    1000 ml/hr

The correct answer is B, 438 ml/hr. The correct volume of the 1000ml bag to administer is 875 ml, which is to be given over 2 hours. Thus you would take 875 ml and divide it by 2 hours which would = 437.5 ml/hr or 438ml/hr (rounded up because it is .5 or higher)

Frequently Asked Questions Regarding the NCLEX

· Am I eligible to write the NCLEX? Contact your Nursing Regulatory Body (NRB). Typically, when you apply for a nursing license or registration within the state/provincial regulatory body that you were educated in you can seek authorization to write the NCLEX exam. The NRB will grant you Authorization to Take the Test (ATT) with instructions on how to schedule your NCLEX exam.

· Where can I take the NCLEX?  The exam can be taken all across the world at any Pearson Vue Testing Centers. The NCLEX does NOT need to be taken in the USA as it is equivalent in every country.

· How many questions are on the exam? 75-145 (As of October 1, 2020).

· What is the style of the NCLEX? The NCLEX uses the Computerized Adaptive Testing (CAT) format.

· How is the NCLEX graded? The NCLEX is a PASS/FAIL exam using the “logit” model which compares your ability to answer questions and the difficulty of the questions themselves. If you are able to correctly answer moderately difficult questions at least 50% of the time you are likely to pass.

     o The exam is completed when there is 95% certainty that your ability was either above or below the passing standard.

· How much time do you have to write the NCLEX? Up to 5 hours.

· How do you apply and register for the NCLEX?  See below for the two step registration process:

• Step i. First, apply for a US State nursing license/registration to a US State Board of Nursing (BON) that you are looking to become licensed in as a Registered Nurse (e.g. Texas Board of Nursing). Once your application is approved by the BON, you will be granted authorization to take the NCLEX-RN exam (ATT)

• (Registration Website for US State Nursing License (BON): https://www.ncsbn.org/contact-bon.htm)

• Step ii. Next, once you receive your ATT you can then register and pay for the NCLEX-RN Exam through Pearson Vue's website online. After your registration is approved, you will then be able to schedule and take the NCLEX-RN exam at any Pearson Vue Testing Centre in the world (tip: you do not need to take the NCLEX-RN exam in Texas to become registered and licensed as an RN in Texas. You can take the NCLEX-RN exam anywhere in the world at any Pearson Vue Testing Centre, such as in the Philippines)

• (Registration Website for Pearson Vue NCLEX-RN Exam: https://portal.ncsbn.org/)
  

· If I fail the NCLEX, how often and how many times can I rewrite it? If you fail the NCLEX you can take the test again after 45 days test-free and up to 8 times a year.

· Can I take the NCLEX outside of my local or desired jurisdiction? Yes, once you are eligible to write the NCLEX you can take the exam at any Pearson Vue Testing Location. I recommend choosing a US state and applying for a “license through examination” meaning that if accepted and you pass the NCLEX-RN exam you will then be licensed in that US state. You do not have to take the NCLEX in that state itself as you can take it elsewhere in the world.

· How long will it take to get my NCLEX results? It can take up to 6 weeks to receive your testing results. In the USA you can access your “unofficial results” within 48 hours for a fee of $7.95 USD.

· Can I skip questions and go back to answer them later? No, you can only answer the questions in the order that you receive them with no opportunity to go back and answer them later.

· Do I get a performance report if I fail the exam? Yes.

· Will the names of medications be the generic or brand names in the NCLEX? The NCLEX generally uses only the generic names of medications.

· What languages are the NCLEX exam offered in? English and French (for French-speaking Canadian candidates).

· Are there breaks during the NCLEX exam? Yes, there are two breaks scheduled after 2 hours and after 3 ½ hours of commencement into the exam (please note: breaks do count towards testing time).

· Can I take the NCLEX during the Covid-19 pandemic? Yes. However, you may be required to wear a face mask.

If you are ready to begin your application to become a US Registered Nurse with Medliant International Healthcare Staffing please reach out to us on the Medliant Website, Facebook (Medliant International Healthcare Staffing), or Instagram (@medliant).

You can also email your resume to nursebrennan@medliant.com to start making your American Dream come true!

Nurse Brennan Belliveau

Email: nursebrennan@medliant.com

Medliant International Healthcare Solution