Question 1

RL is a—?

Accepted Answer

Answer reason: Ringer’s lactate (RL) has an osmolarity close to that of plasma and is classified clinically as an isotonic crystalloid used for fluid resuscitation.

Question 2

Which IV needle gauge and color are typically used for trauma and rapid infusion?

Accepted Answer

Answer reason: For trauma and rapid infusion, a large-bore catheter is required; 14G (orange) provides the highest flow rates for rapid fluid and blood resuscitation.

Question 3

Which-gauge needle is typically used for rapid fluid administration?

Accepted Answer

Answer reason: A lower gauge means a larger bore, enabling the highest flow rates for rapid resuscitation; a 14G catheter is typically used for rapid fluid administration. 18G and 20G catheters allow slower flow, and 24G is small-bore.

Question 4

Which cannula size is used for infants?

Accepted Answer

Answer reason: Infants have small, fragile veins; a small-bore IV catheter, such as a 24-gauge, is preferred to minimize trauma and facilitate cannulation.

Question 5

Normal flush volume administered before and after medication in paediatric patients?

Accepted Answer

Answer reason: Pediatric IV lines are flushed with small volumes to clear the catheter without excess fluid, commonly about 2 mL of normal saline before and after medications.

Question 6

A client with a head injury develops the syndrome of inappropriate antidiuretic hormone (SIADH). Which physician's prescription would the nurse question?

Accepted Answer

Answer reason: In SIADH, there is excess water retention and hyponatremia. D5W becomes free water and is hypotonic, which would worsen hyponatremia and fluid overload and is especially dangerous after head injury. Demeclocycline, daily weights, and strict intake/output are appropriate for SIADH management.

Question 7

In a burn patient, to provide adequate fluids within 24 hours, what intravenous fluid is appropriate?

Accepted Answer

Answer reason: Initial burn resuscitation uses an isotonic crystalloid, specifically Lactated Ringer's, which best matches plasma and helps buffer acidosis. Dextrose solutions are not resuscitative, and NS can cause hyperchloremic acidosis with large volumes.

Question 8

The RN on the oncology unit is preparing to mix and administer amphotericin B (Fungizone) to a client. Which action is contraindicated when administering this drug IV?

Accepted Answer

Answer reason: Conventional amphotericin B must be diluted in D5W only; it is incompatible with normal saline. Slow infusion, prehydration, and premedication are recommended to reduce adverse reactions.

Question 9

What is the IV fluid of choice for a patient with severe dehydration?

Accepted Answer

Answer reason: For rapid volume replacement in severe dehydration/hypovolemia, an isotonic crystalloid is indicated; Ringer lactate is preferred. D5W becomes hypotonic and does not expand intravascular volume, DNS is hypertonic and not first-line for resuscitation, and albumin is not indicated for routine dehydration.

Question 10

A client is undergoing fluid replacement after being burned over 20% of her body 12 hours ago. The nursing assessment reveals a blood pressure of 90/50 mm Hg, a pulse rate of 110 beats per minute, and a urine output of 20 mL in the past hour. The nurse reports the findings to the health care provider (HCP) and anticipates which prescription?

Accepted Answer

Answer reason: Findings indicate hypovolemia during the early burn resuscitation phase (hypotension, tachycardia, low urine output). The appropriate action is to increase isotonic crystalloid (lactated Ringer’s) infusion. Diuretics and D5W are contraindicated; PRBCs are not indicated without hemorrhage.

Question 11

A client is brought to the emergency department unresponsive, and a diagnosis of hyperosmolar hyperglycemic syndrome is made. Which anticipated health care provider's prescription would the nurse immediately prepare to initiate?

Accepted Answer

Answer reason: HHS presents with profound dehydration; the immediate priority is aggressive fluid resuscitation with isotonic saline before insulin therapy. NPH insulin is inappropriate, bicarbonate is not indicated, and intubation is only needed if airway compromise is evident.

Question 12

A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis (DKA). The initial blood glucose level is 950 mg/dL (54.2 mmol/L). A continuous intravenous (IV) infusion of short-acting insulin has been initiated, along with IV rehydration with normal saline. The serum glucose level has now decreased to 240 mg/dL (13.7 mmol/L). Which medication would the nurse prepare to administer next?

Accepted Answer

Answer reason: In DKA, once glucose falls to about 200–250 mg/dL, dextrose is added to IV fluids to prevent hypoglycemia while continuing insulin to clear ketosis.

Question 13

NaCl 0.9% is also called?

Accepted Answer

Answer reason: 0.9% sodium chloride (normal saline) has an osmolarity similar to plasma and is classified as an isotonic solution.

Question 14

DNS fluid contains?

Accepted Answer

Answer reason: DNS stands for Dextrose Normal Saline; it contains glucose (dextrose) with 0.9% sodium chloride.

Question 15

What is NaCl 0.9% (Normal Saline) used for?

Accepted Answer

Answer reason: 0.9% NaCl is an isotonic crystalloid used for volume expansion and maintenance of hydration; it does not rapidly correct sodium, treat hypoglycemia, or manage allergies.

Question 16

Commonest site for IV cannulation in adults?

Accepted Answer

Answer reason: The cephalic vein in the forearm/hand is the most commonly used peripheral site for IV cannulation in adults. Femoral and jugular veins are central access sites, and the radial vein is not typically preferred for routine peripheral IVs.

Question 17

Irritation, swelling, warmth and redness at the intravenous infusion site is the sign of?

Accepted Answer

Answer reason: Localized irritation, swelling, warmth, and erythema at an IV site are classic signs of vein inflammation with clot—thrombophlebitis. Venous thrombosis, bacteremia, and embolism present with broader systemic signs.

Question 18

A client receiving chemotherapy reports severe nausea and vomiting despite taking prescribed antiemetics; which intervention should the nurse prioritize?

Accepted Answer

Answer reason: Severe vomiting puts the client at immediate risk for dehydration and electrolyte imbalance. The priority is to restore and maintain fluid status by administering IV fluids as prescribed. Increasing the antiemetic dose requires a provider order, and dietary or relaxation measures are lower priority in acute dehydration risk.

Question 19

A client with sickle cell disease is admitted in active labor. Which nursing intervention would be most helpful in preventing a sickling crisis?

Accepted Answer

Answer reason: Aggressive hydration decreases blood viscosity and helps prevent sickling during labor. The other options do not directly prevent a crisis.

Question 20

A client arrives in the emergency room with severe burns of the hands, right arm, face, and neck. The nurse needs to start an IV. Which site would be most suitable for this client?

Accepted Answer

Answer reason: Use an unburned extremity and avoid areas of flexion and adult feet. The left forearm provides intact, stable veins; the right hand is burned, the AC fossa is a flexion site, and feet are last-resort in adults.

Question 21

Which type of intravenous fluid should the nurse anticipate administering first to a client admitted with severe dehydration?

Accepted Answer

Answer reason: Initial management of severe dehydration is rapid intravascular volume expansion with an isotonic crystalloid (e.g., 0.9% NS or LR). Hypotonic fluids worsen hypotension, hypertonic saline is reserved for specific indications like severe hyponatremia, and colloids are not first-line for routine volume resuscitation.

Question 22

For a 76-year-old woman, where should the home health nurse start an IV with 5% dextrose in water (D5W)?

Accepted Answer

Answer reason: For older adults, choose a stable, well-supported peripheral vein on the nondominant side and avoid areas of flexion and lower extremities. Forearm dorsal veins provide good flow and reduce complications; leg veins and wrist/hand sites have higher risks of thrombosis, infiltration, and interference with function.

Question 23

Which action should the nurse take before performing venipuncture to initiate continuous intravenous (IV) therapy?

Accepted Answer

Answer reason: Before initiating IV therapy, the nurse must verify the solution and its expiration date to ensure safety and correct therapy. A tourniquet is applied above, not below, the site; cool compress is inappropriate (warmth promotes venous dilation); and an arm board is used after insertion if needed for stabilization.

Question 24

What is the appropriate nursing action when infiltration is observed at the vascular access site during continuous infusion of isotonic fluids?

Accepted Answer

Answer reason: Infiltration indicates the IV is no longer in the vein; the priority is to stop the infusion and remove the catheter to prevent further tissue injury. Then elevate and apply compresses per policy.

Question 25

A client is receiving intravenous (IV) vancomycin. What action should the nurse take to prevent complications?

Accepted Answer

Answer reason: Vancomycin can cause phlebitis and infusion reactions; monitoring the IV site for redness and swelling helps prevent/identify complications. Rapid infusion increases risk (red man syndrome), and the other options are not indicated.

Question 26

First choice of IV puncture site is?

Accepted Answer

Answer reason: Forearm peripheral veins are preferred for IV cannulation: they are accessible, have good flow, and are less prone to kinking and complications compared with hand, foot, or scalp in adults.

Question 27

In hypotension which fluid is provided?

Accepted Answer

Answer reason: Initial fluid for hypotension is an isotonic crystalloid to rapidly expand intravascular volume; 0.9% normal saline is the standard first-line choice. D10% and 3% saline are not used for volume resuscitation, and Ringer lactate is acceptable but NS is the typical initial fluid.

Question 28

Which priority assessment should the nurse make before administering cisplatin to a client with cancer?

Accepted Answer

Answer reason: Cisplatin is a vesicant; extravasation can cause severe tissue injury. Ensuring the IV line is patent is the priority assessment immediately before infusion.

Question 29

Which IV fluid is most appropriate for an obstetric client admitted with dehydration?

Accepted Answer

Answer reason: LR is an isotonic, balanced crystalloid commonly used in obstetrics for volume replacement in dehydration; it restores intravascular volume without unnecessary dextrose. Other dextrose solutions are not first-line for initial rehydration.

Question 30

Which intravenous (IV) complication is characterized by pain, edema, erythema, formation of blisters, necrotic tissue, slough, or eschar due to leakage of a vesicant agent into surrounding tissues?

Accepted Answer

Answer reason: Extravasation is the leakage of a vesicant into surrounding tissue, causing pain, erythema, edema, blistering, and potentially necrosis or eschar. Infiltration involves non-vesicant fluids and does not cause tissue necrosis.

Question 31

Which of the following fluid solutions is hypertonic?

Accepted Answer

Answer reason: D5NS, D5 0.45% NS, and D5 Ringer’s lactate all have osmolarity higher than plasma due to added dextrose, making them hypertonic; therefore all are correct.

Question 32

The nurse is administering an intravenous vesicant chemotherapeutic agent to a client. Which assessment would require the nurse's IMMEDIATE action?

Accepted Answer

Answer reason: Pain at the IV site during infusion of a vesicant suggests extravasation, which can cause tissue necrosis and requires immediate intervention. The other findings are common chemo side effects and are not as urgent.

Question 33

While administering a chemotherapeutic vesicant, the nurse notes that there is a lack of blood return from the IV catheter. The nurse should?

Accepted Answer

Answer reason: Absence of blood return during vesicant chemotherapy suggests possible infiltration/extravasation. The priority is to stop the infusion immediately to prevent tissue injury; do not flush or continue.

Question 34

The physician has ordered Dextrose 5% in normal saline for an infant admitted with gastroenteritis. The advantage of administering the infant's IV through a scalp vein is?

Accepted Answer

Answer reason: Scalp-vein IVs in infants keep the extremities free and are easier to secure, allowing the infant to be held and comforted without dislodging the line. The other statements are incorrect: drug absorption is the same IV, scalp veins can infiltrate, and the scalp is not lacking pain receptors.

Question 35

The nurse is caring for an infant receiving intravenous fluid. Signs of fluid overload in an infant include?

Accepted Answer

Answer reason: Fluid volume excess typically presents with hypertension and a bounding, often tachycardic pulse. Fever is not characteristic of fluid overload, and hypotension/bradycardia suggest volume deficit or shock.

Question 36

Which colour cannula corresponds to 24 gauge?

Accepted Answer

Answer reason: Standard IV cannula color coding: 24-gauge is yellow (22G blue, 20G pink, 18G green).

Question 37

An obstetric client is admitted with dehydration. Which IV fluid would be most appropriate for the client?

Accepted Answer

Answer reason: Dehydration requires isotonic fluid to restore intravascular volume. Lactated Ringer's is isotonic and commonly used in obstetrics; the other options are hypotonic or hypertonic and not first-line for volume replacement.

Question 38

Which of the following is the most common site for venipuncture?

Accepted Answer

Answer reason: The median cubital vein in the antecubital fossa is large, superficial, and well anchored with fewer nearby nerves, making it the preferred and most common site for venipuncture.

Question 39

Which gauge size is appropriate for intravenous therapy?

Accepted Answer

Answer reason: A 20-gauge catheter is the standard size for routine adult IV therapy, providing adequate flow for most fluids and medications with less trauma than large-bore catheters. 16G–18G are for rapid infusions/blood; 22G is used for small or fragile veins with slower flow.

Question 40

What type of solution is 5% dextrose in normal saline (NS)?

Accepted Answer

Answer reason: D5NS has an osmolarity higher than plasma (~560 mOsm/L); therefore it acts as a hypertonic IV solution.

Question 41

The client who is admitted with thrombophlebitis has an order for heparin. The medication should be administered using a/an?

Accepted Answer

Answer reason: Heparin is a high-alert medication requiring precise rate control to prevent overdose or bleeding; it should be infused with an IV infusion device/controller rather than a buretrol, filter, or stop-cock.

Question 42

An elderly client is diagnosed with ovarian cancer. She has surgery followed by chemotherapy with a fluorouracil (Adrucil) IV. What should the nurse do if she notices crystals in the IV medication?

Accepted Answer

Answer reason: Visible crystals indicate precipitation/instability of the IV drug; administering is unsafe. Do not attempt to redissolve or continue. Discard and obtain a new, clear solution.

Question 43

What is the normal flush volume administered before and after medication in pediatric patients?

Accepted Answer

Answer reason: Pediatric IV medication administration typically uses a normal saline flush of about 5–20 mL, adjusted to age, catheter size, and medication. Smaller volumes like 1–2 mL are inadequate; 10–30 mL is generally excessive for pediatrics.

Question 44

Which type of solution is Ringer's Lactate (RL) an example of?

Accepted Answer

Answer reason: Lactated Ringer’s is a balanced crystalloid with osmolarity close to plasma, making it an isotonic IV solution used for volume replacement.

Question 45

What is the correct angle for an intravenous (IV) injection?

Accepted Answer

Answer reason: IV catheter is inserted with bevel up at a shallow angle of about 15–30 degrees to enter the vein; among the options, 30 degrees is correct.

Question 46

What is the appropriate gauge size of the intravenous cannula used for neonates?

Accepted Answer

Answer reason: Neonates have very small, fragile veins; the smallest standard peripheral IV cannula is preferred. A 24G catheter is typically used in neonates to minimize vessel trauma and infiltration risk.

Question 47

Promethazine hydrochloride (Phenergan) 25 mg IV push has been ordered for a patient. Before administering this medication to the patient, the nurse should check the?

Accepted Answer

Answer reason: For an IV push medication—especially a vesicant like promethazine—the priority is to verify IV patency to prevent extravasation and tissue injury. The other options are not required checks immediately prior to this IV push.

Question 48

A woman has returned from surgery after a right mastectomy with an IV of 0.9% NaCl infusing at 100 cc/hour into her left forearm. Several hours later, the IV infiltrates. The nurse is supervising a student nurse preparing to insert a new peripheral intravenous catheter. The nurse would intervene in which of the following situations?

Accepted Answer

Answer reason: IV sites should avoid areas of flexion (near joints) to prevent dislodgement and infiltration. Choosing soft, elastic veins, starting distally, and stabilizing the vein by holding skin taut are correct techniques.

Question 49

A fluid challenge of 250 cc of normal saline infused over 15 min is ordered for a client with possible acute renal failure. The nurse understands that the fluid challenge is given to?

Accepted Answer

Answer reason: A normal-saline fluid challenge is used to determine if oliguria is due to prerenal hypovolemia/dehydration; improved urine output after the bolus supports dehydration. It is not intended to shift fluid intracellularly or simply dilute wastes, and increasing cardiac output is not the primary purpose.

Question 50

Which IV cannula size is typically used for rapid fluid resuscitation in adults?

Accepted Answer

Answer reason: Rapid fluid resuscitation in adult patients requires the fastest possible intravenous flow rate. Larger-bore IV cannulas allow greater fluid flow due to a wider internal diameter, following Poiseuille’s law. Among the available options (14G, 16G, 18G, 20G), 14G has the largest lumen and provides the highest flow rate, making it the preferred choice for rapid fluid resuscitation, trauma management, and massive volume replacement. Smaller gauges such as 18G or 20G do not allow sufficiently rapid infusion in emergency situations.

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