✨ Featured Lessons · Lesson 8 of 8 · 60 sec
Never Push, Never Crush, Never Clamp
🚫 Three nursing 'nevers' that each have a body count. Three exam questions that are gifts if you know them.
💡 Key idea
Potassium is pumped, not pushed. Long-acting pills are swallowed whole. Chest tubes stay open.
🧠 Why it matters
NEVER PUSH potassium IV, at any concentration; a push can stop the heart. Give it only diluted, on an infusion pump, at the prescribed rate (typically no more than 10 mEq/h through a peripheral line). NEVER CRUSH extended-release, sustained-release or enteric-coated tablets (XL, ER, SR, EC, XR on the label); crushing releases a dose meant to last the whole dosing interval (often 12 to 24 hours) all at once, or destroys the coating that protects the stomach or the drug. Ask the pharmacist for an immediate-release form. NEVER CLAMP a chest tube routinely; trapped air builds into a tension pneumothorax. If the tubing disconnects, put the end in sterile water; if the tube comes out, cover the hole with an occlusive dressing taped on three sides.
🏥 In the real world
💊 A busy nurse crushes a client's extended-release metoprolol into applesauce to save a swallowing struggle. The entire 24-hour dose lands at once and the heart rate falls to 38. The letters 'XL' on the label were the whole warning.
📌 Takeaways
- Potassium: never IV push
- XL, ER, SR, EC: never crush
- Chest tube: never clamp; sterile water if disconnected, three-sided dressing if dislodged
✅ Test yourself
A client with a feeding tube is prescribed an extended-release tablet. What should the nurse do?
- Crush it finely and flush well
- Dissolve it in warm water
- Ask the pharmacist for an immediate-release form
- Give it whole through the tube
Answer: C · Ask the pharmacist for an immediate-release form
Extended-release products cannot be crushed or dissolved; the pharmacist or prescriber supplies an alternative formulation.
A client's chest tube becomes disconnected from the drainage system. What is the nurse's immediate action?
- Clamp the tube near the chest
- Reconnect the dirty tubing
- Remove the chest tube
- Place the open end in sterile water
Answer: D · Place the open end in sterile water
Submerging the open end in a container of sterile water creates a water seal that prevents air entry while the system is replaced; clamping risks tension pneumothorax.
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- 2Why Potassium Is the Deadliest Electrolyte
- 3My Chicken Hez TB: Isolation in 60 Seconds
- 4Delegation Cheat Code: Never Delegate What You EAT
- 5The Lab Values You Must Recite in Your Sleep
- 6Late Decels: Four Moves in Sixty Seconds
- 7Insulin Peaks in One Picture
- 8Never Push, Never Crush, Never Clamp