✨ 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 concentrated potassium IV; it stops the heart. Dilute and pump. NEVER CRUSH extended-release, sustained-release or enteric-coated tablets (XL, ER, SR, EC, XR on the label); crushing dumps a whole day's dose 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