NURS 121L-A: Advanced IV Therapy and Fluid Management 2026
|WCU
1. A patient with traumatic brain injury is receiving 3% Sodium Chloride. Which
assessment finding requires the most immediate intervention by the nurse?
A. Serum sodium level of 142 mEq/L
B. Crackles auscultated at the lung bases
C. Patient reports being thirsty
D. Urine output of 40 mL per hour
Answer: B
Rationale: Hypertonic solutions like 3% NaCl shift fluid into the vascular space, posing a
high risk for pulmonary edema and fluid volume overload, evidenced by crackles.
2. The nurse is monitoring a patient receiving a potassium chloride infusion for
severe hypokalemia. Which of the following actions is a priority safety
standard?
A. Administering the medication via IV push over 2 minutes
B. Checking for a positive Trousseau sign before administration
C. Ensuring the infusion rate does not exceed 10 mEq/hr in a peripheral line
D. Restricting oral fluid intake during the infusion
Answer: C
Rationale: Potassium must never be given IV push due to the risk of cardiac arrest. The
standard maximum rate for peripheral administration is generally 10 mEq/hr.
,3. A patient is diagnosed with hypervolemic hyponatremia. Which IV fluid order
should the nurse question?
A. 3% Sodium Chloride
B. 0.45% Sodium Chloride
C. 0.9% Sodium Chloride
D. Lactated Ringer’s
Answer: B
Rationale: 0.45% NaCl is hypotonic and would further dilute the extracellular fluid,
worsening hyponatremia and cellular swelling.
4. During the assessment of a peripheral IV site, the nurse notes coolness,
pallor, and significant swelling. The infusion has stopped. Which complication
has occurred?
A. Phlebitis
B. Thrombosis
C. Extravasation
D. Infiltration
Answer: D
Rationale: Infiltration is characterized by coolness, swelling, and pallor. Extravasation
involves vesicants and tissue damage; phlebitis involves warmth and redness.
5. Which electrolyte imbalance is most likely to cause a prolonged QT interval
and a positive Chvostek sign?
A. Hypocalcemia
B. Hypermagnesemia
C. Hyperkalemia
D. Hyponatremia
Answer: A
, Rationale: Hypocalcemia increases neuromuscular excitability, leading to Chvostek’s sign,
and can prolong the QT interval on an EKG.
6. A patient with end-stage renal disease presents with a potassium level of 7.2
mEq/L and peaked T-waves. Which medication should be administered first to
protect the heart?
A. Sodium Polystyrene Sulfonate (Kayexalate)
B. Furosemide (Lasix)
C. Calcium Gluconate
D. Regular Insulin and D50
Answer: C
Rationale: Calcium gluconate does not lower potassium but stabilizes the myocardial cell
membrane to prevent lethal arrhythmias in severe hyperkalemia.
7. Which IV solution is considered the fluid of choice for initial resuscitation in a
patient with hypovolemic shock?
A. Lactated Ringer’s
B. 0.45% Normal Saline
C. D5W
D. D5 1/2 Normal Saline
Answer: A
Rationale: Isotonic crystalloids like Lactated Ringer’s or 0.9% NaCl are preferred for
volume expansion as they stay in the intravascular compartment.
|WCU
1. A patient with traumatic brain injury is receiving 3% Sodium Chloride. Which
assessment finding requires the most immediate intervention by the nurse?
A. Serum sodium level of 142 mEq/L
B. Crackles auscultated at the lung bases
C. Patient reports being thirsty
D. Urine output of 40 mL per hour
Answer: B
Rationale: Hypertonic solutions like 3% NaCl shift fluid into the vascular space, posing a
high risk for pulmonary edema and fluid volume overload, evidenced by crackles.
2. The nurse is monitoring a patient receiving a potassium chloride infusion for
severe hypokalemia. Which of the following actions is a priority safety
standard?
A. Administering the medication via IV push over 2 minutes
B. Checking for a positive Trousseau sign before administration
C. Ensuring the infusion rate does not exceed 10 mEq/hr in a peripheral line
D. Restricting oral fluid intake during the infusion
Answer: C
Rationale: Potassium must never be given IV push due to the risk of cardiac arrest. The
standard maximum rate for peripheral administration is generally 10 mEq/hr.
,3. A patient is diagnosed with hypervolemic hyponatremia. Which IV fluid order
should the nurse question?
A. 3% Sodium Chloride
B. 0.45% Sodium Chloride
C. 0.9% Sodium Chloride
D. Lactated Ringer’s
Answer: B
Rationale: 0.45% NaCl is hypotonic and would further dilute the extracellular fluid,
worsening hyponatremia and cellular swelling.
4. During the assessment of a peripheral IV site, the nurse notes coolness,
pallor, and significant swelling. The infusion has stopped. Which complication
has occurred?
A. Phlebitis
B. Thrombosis
C. Extravasation
D. Infiltration
Answer: D
Rationale: Infiltration is characterized by coolness, swelling, and pallor. Extravasation
involves vesicants and tissue damage; phlebitis involves warmth and redness.
5. Which electrolyte imbalance is most likely to cause a prolonged QT interval
and a positive Chvostek sign?
A. Hypocalcemia
B. Hypermagnesemia
C. Hyperkalemia
D. Hyponatremia
Answer: A
, Rationale: Hypocalcemia increases neuromuscular excitability, leading to Chvostek’s sign,
and can prolong the QT interval on an EKG.
6. A patient with end-stage renal disease presents with a potassium level of 7.2
mEq/L and peaked T-waves. Which medication should be administered first to
protect the heart?
A. Sodium Polystyrene Sulfonate (Kayexalate)
B. Furosemide (Lasix)
C. Calcium Gluconate
D. Regular Insulin and D50
Answer: C
Rationale: Calcium gluconate does not lower potassium but stabilizes the myocardial cell
membrane to prevent lethal arrhythmias in severe hyperkalemia.
7. Which IV solution is considered the fluid of choice for initial resuscitation in a
patient with hypovolemic shock?
A. Lactated Ringer’s
B. 0.45% Normal Saline
C. D5W
D. D5 1/2 Normal Saline
Answer: A
Rationale: Isotonic crystalloids like Lactated Ringer’s or 0.9% NaCl are preferred for
volume expansion as they stay in the intravascular compartment.
