Intravenous Therapy Practice Test 4
Intravenous Therapy NCLEX Practice Test
Intravenous Therapy is a key topic within the NCLEX test plan, located under Physiological Integrity → Pharmacological and Parenteral Therapies → Intravenous Therapy. This section manages IV fluids, site assessment, and complication prevention to maintain vascular integrity. Each test contains 50 questions designed to mirror the difficulty and variety of the real exam.
This is the 4th part of the Intravenous Therapy series. To explore all practice tests under this topic, use the “Back to Main Topic” button at the end of the page.
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Intravenous Therapy Practice Test 4
The nurse is monitoring the status of a client's fat emulsion (lipid) infusion and notices that the infusion is 1 hour behind. Which action should the nurse take?
- Adjust the infusion rate to catch up over the next hour.
- Increase the infusion rate to catch up over the next 2 hours.
- Ensure that the fat emulsion infusion rate is infusing at the prescribed rate.
- Adjust the infusion rate to run wide open until the solution is back on time.
Explanation: Answer reason: IV lipid emulsions should be infused at an ordered rate because rapid infusion increases the risk of adverse effects such as fat overload syndrome and metabolic/respiratory complications. When an infusion is behind schedule, the safe first step is to verify the pump settings and assess for causes (e.g., occlusion, infiltration, tubing/pump error) rather than compensating by speeding up delivery. “Catching up” by increasing the rate or running the infusion wide open can deliver an unintended bolus and exceed recommended hourly limits. Maintaining the prescribed rate supports safe, controlled administration and prompts correction of the underlying issue.
The nurse is assessing a client's peripheral intravenous (IV) site after completion of a vancomycin infusion and notes that the area is reddened, warm, painful, and slightly edematous proximal to the insertion point of the IV catheter. At this time, which action by the nurse is best?
- Check for the presence of blood return.
- Remove the IV site and restart at another site.
- Document the findings and continue to monitor the IV site.
- Call the health care provider (HCP) and request that the vancomycin be given orally.
Explanation: Answer reason: The findings (redness, warmth, pain, and edema tracking proximal to the insertion site) are most consistent with phlebitis and/or infiltration related to peripheral IV therapy. The safest immediate nursing action is to stop using the affected vein by discontinuing the catheter, because continuing infusion can worsen tissue injury and inflammation. Restarting at a new site preserves venous access while preventing further damage at the compromised site. Merely checking for blood return or continuing to monitor delays definitive management, and requesting oral vancomycin is not an appropriate first response because it does not address the local IV complication and oral vancomycin is typically reserved for specific indications (e.g., C. difficile colitis).
Which of the following injection should not mixed with dopamine for infusion through a central line?
- Potassium chloride
- Calcium gluconate
- Soda bicarbonate
- Dobutamine
Explanation: Answer reason: Dopamine is unstable in alkaline solutions, and sodium bicarbonate raises pH, which can inactivate the catecholamine and/or cause incompatibility in the line. This can lead to reduced therapeutic effect and potential line occlusion. In contrast, electrolytes like potassium chloride are commonly Y-sited with many fluids when verified compatible and do not have the same strong alkalinizing effect that drives dopamine instability.
A patient with ventricular tachycardia has been ordered to receive IV (intravenous) lidocaine. What does the nurse dilute the lidocaine solution with?
- Normal Saline 0.9%.
- 5% Dextrose in water.
- Normal Saline 0.45%.
- Lactated Ringers.
Explanation: Answer reason: IV lidocaine infusions are prepared in compatible diluents to maintain drug stability and prevent precipitation or loss of potency during administration. Dextrose 5% in water is a standard compatible diluent for lidocaine continuous infusion used for ventricular dysrhythmias. Using an incompatible solution risks reduced therapeutic effect or infusion complications, which is especially unsafe when treating ventricular tachycardia. Normal saline or lactated Ringer’s may be used for many IV drugs, but for lidocaine infusion D5W is the commonly specified compatible diluent in clinical practice and exam references.
The nurse is checking on clients in the unit. Which of these findings indicates that an infusion pump set to deliver a morphine drip basal rate of 10 mL per hour, plus PRN dosages for breakthrough pain, is not functioning correctly?
- The client states: "I just can't get relief from my pain."
- The level of the drug is 100 mL at 9 am and is 50 mL at 12 noon
- The level of the drug is 100 mL at 8 am and is 80 mL at 12 noon
- The client complains of discomfort at the IV insertion site
Explanation: Answer reason: From 8 am to 12 noon is 4 hours, so at 10 mL/hr the pump should infuse about 40 mL (leaving ~60 mL from a 100 mL starting volume), and PRN doses would make the volume decrease even more. A drop of only 20 mL over 4 hours indicates under-infusion or an occlusion/flow problem despite the ordered basal rate. By contrast, the 9 am to 12 noon change from 100 mL to 50 mL (50 mL over 3 hours) could be explained by the basal infusion plus PRN breakthrough doses rather than pump malfunction.
A newborn admitted with pyloric stenosis is lethargic and has poor skin turgor. The health-care provider has prescribed IV fluids of dextrose water with sodium and potassium. The baby's admission potassium level is 3.4 mEq/L. What should the nurse do first?
- Notify the HCP.
- Administer the prescribed fluids.
- Verify that the infant has urinated.
- Have the potassium level redrawn.
Explanation: Answer reason: Potassium should not be administered until adequate renal function is confirmed because impaired urine output can rapidly lead to dangerous hyperkalemia and dysrhythmias. An infant with pyloric stenosis is often dehydrated from vomiting, increasing the risk of oliguria and reduced potassium excretion. The immediate nursing priority before starting fluids containing potassium is to verify urine output (e.g., wet diaper) to ensure the kidneys can clear potassium safely. A potassium of 3.4 mEq/L is only mildly low and does not override the safety check required prior to giving IV potassium.
The nurse reviews prescriptions for assigned adult clients. Which prescription should the nurse question?
- 0.45% sodium chloride (NaCl) solution prescribed for a client with syndrome of inappropriate antidiuretic hormone secretion who has a sodium level of 120 mEq/L (120 mmol/L)
- 0.9% NaCl solution prescribed for a client with gastrointestinal bleeding who has a hemoglobin level of 8.9 g/dL (89 g/L)
- 1,000 mL bolus of 0.9% NaCl solution prescribed for a client with septic shock who has a white blood cell count of 18,000/mm3 (18.0 × 109/L)
- Lactated Ringer's solution prescribed for a male client with hypovolemic shock and a thermal burn who has a hematocrit level of 56% (0.56)
Explanation: Answer reason: 0.45% sodium chloride (NaCl) solution prescribed for a client with syndrome of inappropriate antidiuretic hormone secretion who has a sodium level of 120 mEq/L (120 mmol/L) Severe hyponatremia in SIADH reflects excess free water relative to sodium, so treatment generally requires fluid restriction and, when symptomatic or very low, hypertonic saline to raise serum sodium safely. A hypotonic IV fluid provides additional free water and can further dilute serum sodium, worsening cerebral edema and neurologic risk. In contrast, isotonic crystalloids are appropriate for volume resuscitation in septic shock and hypovolemic burn shock, and isotonic saline can be used to support intravascular volume in GI bleeding while definitive therapy (including blood products as indicated) is arranged. Therefore the hypotonic maintenance fluid order is the one that is unsafe and should be questioned.
The nurse plans to start an IV line on a female client hospitalized with pneumonia. The nurse reviews the electronic medical record for relevant information and learns that the client is right-handed and has a history of a left-sided mastectomy with lymph node removal. Which site is best for the nurse to select for the client's IV line?
- Basilic vein of the left forearm
- Cephalic vein in the right antecubital space
- Median vein of the right forearm
- Radial vein of the left wrist
Explanation: Answer reason: Therefore, the right arm is preferred over the left arm for venipuncture and IV therapy in this client. A forearm site is generally more stable and allows greater mobility than an antecubital site, which is prone to occlusion and infiltration with elbow flexion. Selecting a vein in the right forearm balances safety (avoiding the affected limb) with practicality and lower complication risk compared with the antecubital fossa.
A nurse provides IV fluid resuscitation for a client with infectious colitis and dehydration. The nurse understands what intravenous solution is best for this client?
- Ringer lactate
- 0.9% normal saline
- 5% dextrose in 0.45% normal saline
- 5% dextrose in water
Explanation: Answer reason: Initial IV resuscitation for dehydration from infectious diarrhea should use an isotonic crystalloid to rapidly expand intravascular volume and restore perfusion. This fluid stays primarily in the extracellular space, making it appropriate for acute volume depletion. Dextrose-containing solutions become effectively hypotonic after metabolism and are poor choices for bolus resuscitation because they do not sustain intravascular expansion. A common pitfall is selecting hypotonic maintenance fluids (e.g., dextrose with half-normal saline) too early, which can worsen hyponatremia risk in ongoing GI losses.
The nurse administers an IV antibiotic to a patient receiving TPN via a central venous catheter. What does the nurse do first?
- Check compatibility of antibiotic and TPN.
- Turn TPN off for 30 minutes.
- Flush central line with normal saline.
- Ensure separate IV access route.
Explanation: Answer reason: TPN is a high-risk, hypertonic solution that should run on a dedicated lumen to prevent incompatibility, precipitation, and interruption of critical nutrition/insulin coverage. Before giving an IV antibiotic, the priority safety action is to verify there is a separate IV route (another lumen or peripheral line) so the medication does not mix with TPN in the tubing. Compatibility checks and line flushing are secondary once a safe access plan is confirmed; flushing a lumen used for TPN can also unnecessarily interrupt the infusion and increase line manipulation. Simply turning off TPN for a set time is not a standard first step and can risk glycemic instability without solving the access/compatibility issue.
A nurse discovers that an infusion of peripheral parenteral nutrition (PPN) is empty, and a replacement bag is not yet ready. What should the nurse do next while waiting for the PPN bag?
- Hang an intravenous infusion of 10% dextrose in water.
- Hang an intravenous infusion of normal saline.
- Hang an intravenous infusion of 20% dextrose in water.
- Convert the intravenous infusion to a saline lock.
Explanation: Answer reason: Abrupt interruption of parenteral nutrition can cause hypoglycemia because the patient’s insulin levels may remain elevated after a continuous glucose infusion stops. The safest immediate action is to maintain a dextrose-containing IV at a similar osmolarity appropriate for peripheral access until the next bag is available. Normal saline or a saline lock would not provide glucose and increases risk for symptomatic hypoglycemia. D20W is typically too hypertonic for peripheral infusion and raises risk of phlebitis or vein injury.
A nurse is preparing to administer 2 continuous IV medications concurrently via a 20-gauge IV. What is the nurse's priority action?
- Assess the condition of the IV site
- Check 2 client identifiers before administering medications
- Consult a medication guide for compatibility
- Wash hands prior to administering medications
Explanation: Answer reason: Verifying compatibility (or the need for separate lumens/Y-site restrictions and required flushing) directly addresses the unique hazard created by concurrent infusion through a single peripheral IV. Checking identifiers and hand hygiene are essential safety steps but do not specifically mitigate the immediate risk of mixing two infusions in one line. Assessing the IV site is important, yet even a healthy site does not prevent an incompatibility reaction occurring within the tubing or catheter.
A health care provider has written a prescription to discontinue an intravenous (IV) line. The nurse should obtain which item from the unit supply area for applying pressure to the site after removing the IV catheter?
- Elastic wrap
- Povidone iodine swab
- Adhesive bandage
- Sterile 2 × 2 gauze
Explanation: Answer reason: A sterile gauze pad provides a clean, absorbent surface that allows firm, focused pressure while also protecting the open puncture from contamination. An adhesive bandage is typically applied after bleeding has stopped, but it does not provide adequate pressure during the initial hemostasis phase. Elastic wrap and povidone-iodine swab are not primary tools for immediate direct pressure at a peripheral IV removal site.
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