The Basics
This device is inserted into a vein to provide fluids or medications.
Peripheral IV catheter
A patient has 0.9% NS infusing through a peripheral IV at 125 mL/hr. The pump begins alarming. The nurse finds the IV site cool, pale, swollen, and tender. The patient says, “It started hurting about 10 minutes ago.” Name the complication and the nurse's first action.
Infiltration, stop the infusion immediately.
The nurse needs to infuse 1,000 mL of IV fluid over 8 hours. What rate should the nurse program into the IV pump?
125 mL/hr
A nurse notices that a patient's IV fluids have infused much faster than prescribed. Which assessment finding would be most concerning?
A. Dry mucous membranes and thirst
B. Decreased urine output and constipation
C. Shortness of breath and crackles in the lungs
D. Redness and tenderness at the IV insertion site
C.
Rational: Rapid infusions can lead to circulatory overload which is an emergency.
The nurse is preparing to program an electronic IV infusion pump. Which unit of measurement is used to set the IV infusion rate?
mL/hr
Rational: Electronic IV infusion pumps are commonly programmed to deliver a prescribed volume of fluid in milliliters per hour (mL/hr).
A patient is receiving a continuous IV infusion of unfractionated heparin. Which laboratory tests may be used to monitor the patient's response to heparin? SELECT ALL THAT APPLY.
A. INR
B. aPTT
C. Anti-factor Xa
D. Hemoglobin A1C
E. Troponin
B & C
Before giving an IV medication through an existing line, the nurse must determine whether the medication is compatible with these.
The IV solution being used.
The nurse assesses a patient's peripheral IV site and notes redness, warmth, tenderness, and swelling along the vein. Which complication should the nurse suspect?
Phlebitis
The provider orders morphine 6 mg IM. Available: morphine 10 mg/mL. How many mL should the nurse administer?
0.6mL
The nurse is preparing to insert a peripheral IV in an adult patient. Which site should the nurse generally attempt first when appropriate?
Distal vein on the hand or forearm
A patient has had several days of vomiting and diarrhea. The patient is hypotensive, tachycardic, and has dry mucous membranes. The provider prescribes IV fluid replacement. Which type of IV solution would the nurse expect to be used initially to expand the intravascular volume?
A. Hypotonic solution
B. Isotonic solution
C. Hypertonic solution
D. Sterile water
B.
Rationale: Isotonic solutions such as 0.9% NS and Lactated Ringer's primarily expand extracellular/intravascular volume without causing a major net shift of water into or out of cells.
The nurse assesses a patient and notes bilateral crackles in the lungs, shortness of breath, and 2+ pitting edema in both lower legs. Which medication would the nurse anticipate administering?
A. Heparin
B. Morphine
C. Furosemide
D. Naloxone
C.
Crackles, dyspnea, and peripheral edema are signs of fluid volume excess. Furosemide is a loop diuretic that promotes the excretion of sodium and water, helping decrease excess fluid.
A patient has a medication continuously infusing through a peripheral IV. At a minimum, how often should the nurse assess the IV site for complications?
Every hour
A patient is receiving a vesicant medication through a peripheral IV. The patient suddenly reports burning and pain, and the nurse observes swelling at the site. Which complication should the nurse suspect?
Extravasation.
Of the possible complications, this would definitely be the worse.
The nurse needs to infuse 1,000 mL of 0.9% NS over 8 hours using IV tubing with a drop factor of 15 gtt/mL. How many drops per minute (gtt/min) should the nurse regulate the IV to deliver?
31 gtt/min
The nurse needs to start an IV for an adult patient who will receive routine IV fluids and intermittent antibiotics. Which catheter would generally be most appropriate?
A. 14-gauge
B. 16-gauge
C. 20- or 22-gauge
D. 25-gauge
C.
Rationale: A 20- or 22-gauge peripheral catheter is commonly appropriate for routine fluids and many intermittent IV medications. The nurse should select the smallest gauge that will safely accommodate the prescribed therapy.
A patient with hypernatremia is prescribed a hypotonic IV solution. Which effect should the nurse expect as the solution is administered?
A. Water moves from the cells into the bloodstream
B. Water remains entirely within the vascular space
C. Water moves from the extracellular space into the cells
D. Water is pulled from both the cells and interstitial space into the bloodstream
C.
Hypotonic solutions have a lower effective concentration than plasma, promoting movement of water into cells.
A patient receiving IV furosemide for pulmonary edema has which finding that requires the nurse's immediate attention?
A. Decreased ankle edema
B. Increased urine output
C. Improved breath sounds
D. Potassium 2.8 mEq/L
D.
The range for K+ is 3.5-5.0
What is the most common reason a hospitalized patient needs IV access?
To administer fluids and medications.
While changing IV tubing, air accidentally enters the patient's IV line. The patient suddenly develops shortness of breath, chest pain, and tachycardia. Which complication should the nurse suspect?
Air Embolism
Rational: Sudden dyspnea, chest pain, tachycardia, and cardiovascular/respiratory changes after air enters the IV system can indicate an air embolism and require immediate intervention.
The nurse needs to infuse 500 mL of Lactated Ringer's over 4 hours. The IV tubing has a drop factor of 20 gtt/mL. How many gtt/min should the nurse regulate the IV to deliver?
42 gtt/min
The nurse is unsuccessful when attempting to insert an IV into a vein in the patient's forearm. Which site would be most appropriate for the next attempt?
A. A vein proximal to the previous attempt on the same extremity
B. A vein distal to the previous attempt on the same extremity
C. The exact same insertion site
D. A vein directly over a joint
A.
Rationale: If another attempt is made on the same extremity, a site proximal to the previous attempt should be selected. Starting distal preserves proximal sites for subsequent attempts
A patient is receiving D5W through a peripheral IV. The nurse remembers that D5W is isotonic in the IV bag. What happens after the dextrose is metabolized?
A. It continues to act as an isotonic solution
B. It becomes hypertonic and draws water from the cells
C. It produces a hypotonic effect as free water remains
D. It remains entirely within the intravascular space
C.
D5W is approximately isotonic in the bag, but after the glucose is metabolized, it leaves free water, producing a physiologically hypotonic effect.
The nurse is preparing to administer IV morphine for severe pain. Which assessment finding is most important to evaluate before administering the medication?
A. Temperature and oxygen saturation
B. Blood pressure and temperature
C. Respiratory rate and heart rate
D. Pain level and temperature
C.
Rational:Morphine can cause respiratory depression, sedation, hypotension, and bradycardia. Respiratory status is especially important to assess before and after administration.
A patient is prescribed an IV antibiotic to infuse over 30 minutes every 6 hours. How should the nurse classify this IV therapy?
Intermittent infusions
An IV pump alarms “occlusion.” The nurse finds that all clamps are open and the tubing is not kinked. The IV site has no redness or swelling. What should the nurse do next?
A. Increase the pressure setting on the IV pump
B. Forcefully flush the IV with normal saline
C. Assess the IV for patency according to facility policy
D. Silence the alarm and restart the infusion
C.
Rational: An occlusion can prevent IV fluids or medications from flowing. After checking for simple mechanical causes such as closed clamps, kinked tubing, or patient positioning, the nurse should assess catheter patency. Never force a flush against resistance, as this could damage the catheter or dislodge material.
The nurse needs to infuse an IV antibiotic in 100 mL of NS over 30 minutes. The IV tubing has a drop factor of 15 gtt/mL. How many gtt/min should the nurse regulate the IV to deliver?
50 gtt/min
The nurse is preparing to insert a peripheral IV. Which patient would require the nurse to select the IV extremity most carefully?
A. A patient with a history of hypertension
B. A patient receiving oral acetaminophen
C. A patient who has had lymph nodes removed from one side
D. A patient with bilateral ankle edema
C.
Rationale: An extremity affected by lymph node dissection may have impaired lymphatic drainage and is generally avoided for venipuncture/IV placement when feasible, following current facility policy and the patient's clinical circumstances.
A patient with severe symptomatic hyponatremia is receiving 3% sodium chloride. Which new assessment finding requires the nurse's most immediate attention?
A. Increased thirst
B. Urine output of 50 mL/hr
C. Sodium level beginning to increase
D. New dyspnea and bilateral crackles
D.
3% sodium chloride is hypertonic and pulls water into the extracellular/intravascular space. The patient must be closely monitored for circulatory overload and pulmonary edema, as well as overly rapid correction of sodium.
A patient develops an anaphylactic reaction after receiving an IV medication. Which assessment finding is most concerning for laryngeal obstruction?
A. Itching and hives
B. Nausea and abdominal cramping
C. Stridor and difficulty breathing
D. Redness at the IV site
C.
Rationale: Stridor is a high-pitched sound caused by narrowing of the upper airway and can indicate laryngeal edema and impending airway obstruction during anaphylaxis. This is an emergency requiring immediate intervention.