ATI Intravenous Therapy Nursing Exam Preparation
Guide: Comprehensive Review of IV Catheter
Placement, Fluid Replacement Therapy, Medication
Infusions, Nursing Interventions, Safety Practices, and
Clinical Applications
1. A nurse is preparing to insert a peripheral IV catheter. Which of the following
actions should the nurse take first?
A. Apply a tourniquet 4-6 inches above the selected site.
B. Cleanse the site with chlorhexidine using a back-and-forth friction scrub.
C. Select a vein that is soft and bouncy.
D. Perform hand hygiene and don gloves.
Answer: D. Perform hand hygiene and don gloves.
Rationale: Hand hygiene and applying gloves are the first steps in any aseptic
procedure to prevent infection. Vein selection, tourniquet application, and site
cleansing occur after this initial preparation.
2. A nurse is selecting a vein for peripheral IV insertion. Which of the following
sites should the nurse choose first?
A. The cephalic vein in the forearm.
B. The basilic vein in the upper arm.
C. The dorsal venous network on the hand.
D. The saphenous vein in the foot.
Answer: A. The cephalic vein in the forearm.
Rationale: The veins of the forearm (cephalic, basilic, median cubital) are
preferred for peripheral IV insertion because they are large, well-anchored, and
allow for patient comfort and mobility. The dorsal veins of the hand may be used
but are more fragile and painful.
3. A nurse has just inserted a peripheral IV catheter and observes blood return
in the flashback chamber. Which of the following actions should the nurse
perform next?
A. Release the tourniquet.
,B. Lower the catheter until it is almost flush with the skin.
C. Advance the catheter into the vein with the finger hub.
D. Secure the catheter with a transparent dressing.
Answer: C. Advance the catheter into the vein with the finger hub.
Rationale: Once blood return is observed, the nurse should advance the catheter
into the vein using the finger hub. This ensures the catheter is properly placed
within the vein's lumen. The tourniquet should be released after the catheter is
successfully advanced.
4. A nurse is inserting an IV catheter. After the catheter is inserted and blood
return is confirmed, the nurse should advance the catheter:
A. Until the hub is flush with the skin.
B. Approximately 1/8 to 1/4 inch further.
C. Until resistance is met.
D. To the full length of the catheter.
Answer: B. Approximately 1/8 to 1/4 inch further.
Rationale: After observing flashback, the catheter is advanced a small amount
(1/8 to 1/4 inch) to ensure the entire catheter tip is within the vein lumen before
advancing it off the stylet.
5. A nurse has inserted a peripheral IV catheter. Which gauge catheter is most
appropriate for a client who will receive a blood transfusion?
A. 14-gauge
B. 18-gauge
C. 22-gauge
D. 24-gauge
Answer: B. 18-gauge.
Rationale: An 18-gauge catheter is the standard size for blood transfusions
because it allows blood cells to pass through without hemolysis. Larger gauges
(14-16) are used for rapid fluid resuscitation, while smaller gauges (22-24) are
used for fragile veins and medication administration.
6. A nurse is selecting an IV catheter gauge for a client who requires a rapid
infusion of IV fluids. Which of the following gauges is most appropriate?
A. 14-gauge
,B. 18-gauge
C. 20-gauge
D. 22-gauge
Answer: A. 14-gauge.
Rationale: A 14-gauge catheter is the largest and provides the highest flow rate,
making it ideal for rapid fluid resuscitation in emergencies or trauma situations.
7. A nurse is preparing to initiate IV therapy on an older adult client. Which of
the following actions is appropriate?
A. Apply the tourniquet tightly to visualize veins better.
B. Use a 22-gauge catheter to minimize trauma to fragile veins.
C. Insert the IV in the client's dominant arm for better mobility.
D. Use a 16-gauge catheter for rapid fluid administration.
Answer: B. Use a 22-gauge catheter to minimize trauma to fragile veins.
Rationale: Older adults often have fragile, rolling veins. Using a smaller gauge
catheter (22-24 gauge) minimizes trauma and reduces the risk of infiltration.
8. A nurse is preparing to insert a peripheral IV. Which of the following veins
should be avoided due to the risk of nerve damage?
A. Cephalic vein
B. Basilic vein
C. Median cubital vein
D. Dorsal venous arch
Answer: B. Basilic vein.
Rationale: The basilic vein is located near the brachial artery and median nerve. It
is typically the last choice for venipuncture due to the increased risk of nerve
injury.
9. A nurse is preparing to insert an IV in a client's forearm. After applying the
tourniquet, the vein is not prominent. Which of the following actions should the
nurse take?
A. Remove the tourniquet and apply a warm compress for 5-10 minutes.
B. Slap the vein to make it dilate.
C. Have the client dangle the arm below the heart.
D. Apply the tourniquet tighter.
, Answer: A. Remove the tourniquet and apply a warm compress for 5-10
minutes.
Rationale: Applying heat promotes vasodilation, making veins more prominent.
The tourniquet should be removed before applying heat to avoid prolonged
venous stasis. Slapping the vein is contraindicated.
10. A nurse is inserting a peripheral IV. The client reports a sharp, shooting pain
down the arm during insertion. Which of the following actions should the nurse
take?
A. Continue advancing the catheter and reassure the client.
B. Withdraw the needle immediately and apply pressure.
C. Flush the catheter with normal saline to check for patency.
D. Slightly withdraw the needle and redirect it.
Answer: B. Withdraw the needle immediately and apply pressure.
Rationale: Sharp, shooting pain radiating down the arm indicates possible nerve
puncture. The needle should be withdrawn immediately to prevent nerve
damage. Pressure should be applied to the site to stop any bleeding.
11. A nurse is preparing to insert an IV in a client with a history of mastectomy
on the right side. Which site is appropriate?
A. Right arm (same side as mastectomy)
B. Left arm (opposite side)
C. Dorsal veins of the right foot
D. External jugular vein
Answer: B. Left arm (opposite side).
Rationale: Venipuncture should be avoided on the arm ipsilateral (same side) to a
mastectomy due to the risk of lymphedema and compromised circulation.
12. A nurse is inserting an IV in a client's forearm. After inserting the catheter,
the nurse notes a slow blood return. Which of the following actions should the
nurse take?
A. Flush the catheter with 5 mL of normal saline and assess for swelling.
B. Remove the catheter and reattempt at a different site.
C. Advance the catheter further into the vein.
D. Connect the IV tubing and start the infusion.
Guide: Comprehensive Review of IV Catheter
Placement, Fluid Replacement Therapy, Medication
Infusions, Nursing Interventions, Safety Practices, and
Clinical Applications
1. A nurse is preparing to insert a peripheral IV catheter. Which of the following
actions should the nurse take first?
A. Apply a tourniquet 4-6 inches above the selected site.
B. Cleanse the site with chlorhexidine using a back-and-forth friction scrub.
C. Select a vein that is soft and bouncy.
D. Perform hand hygiene and don gloves.
Answer: D. Perform hand hygiene and don gloves.
Rationale: Hand hygiene and applying gloves are the first steps in any aseptic
procedure to prevent infection. Vein selection, tourniquet application, and site
cleansing occur after this initial preparation.
2. A nurse is selecting a vein for peripheral IV insertion. Which of the following
sites should the nurse choose first?
A. The cephalic vein in the forearm.
B. The basilic vein in the upper arm.
C. The dorsal venous network on the hand.
D. The saphenous vein in the foot.
Answer: A. The cephalic vein in the forearm.
Rationale: The veins of the forearm (cephalic, basilic, median cubital) are
preferred for peripheral IV insertion because they are large, well-anchored, and
allow for patient comfort and mobility. The dorsal veins of the hand may be used
but are more fragile and painful.
3. A nurse has just inserted a peripheral IV catheter and observes blood return
in the flashback chamber. Which of the following actions should the nurse
perform next?
A. Release the tourniquet.
,B. Lower the catheter until it is almost flush with the skin.
C. Advance the catheter into the vein with the finger hub.
D. Secure the catheter with a transparent dressing.
Answer: C. Advance the catheter into the vein with the finger hub.
Rationale: Once blood return is observed, the nurse should advance the catheter
into the vein using the finger hub. This ensures the catheter is properly placed
within the vein's lumen. The tourniquet should be released after the catheter is
successfully advanced.
4. A nurse is inserting an IV catheter. After the catheter is inserted and blood
return is confirmed, the nurse should advance the catheter:
A. Until the hub is flush with the skin.
B. Approximately 1/8 to 1/4 inch further.
C. Until resistance is met.
D. To the full length of the catheter.
Answer: B. Approximately 1/8 to 1/4 inch further.
Rationale: After observing flashback, the catheter is advanced a small amount
(1/8 to 1/4 inch) to ensure the entire catheter tip is within the vein lumen before
advancing it off the stylet.
5. A nurse has inserted a peripheral IV catheter. Which gauge catheter is most
appropriate for a client who will receive a blood transfusion?
A. 14-gauge
B. 18-gauge
C. 22-gauge
D. 24-gauge
Answer: B. 18-gauge.
Rationale: An 18-gauge catheter is the standard size for blood transfusions
because it allows blood cells to pass through without hemolysis. Larger gauges
(14-16) are used for rapid fluid resuscitation, while smaller gauges (22-24) are
used for fragile veins and medication administration.
6. A nurse is selecting an IV catheter gauge for a client who requires a rapid
infusion of IV fluids. Which of the following gauges is most appropriate?
A. 14-gauge
,B. 18-gauge
C. 20-gauge
D. 22-gauge
Answer: A. 14-gauge.
Rationale: A 14-gauge catheter is the largest and provides the highest flow rate,
making it ideal for rapid fluid resuscitation in emergencies or trauma situations.
7. A nurse is preparing to initiate IV therapy on an older adult client. Which of
the following actions is appropriate?
A. Apply the tourniquet tightly to visualize veins better.
B. Use a 22-gauge catheter to minimize trauma to fragile veins.
C. Insert the IV in the client's dominant arm for better mobility.
D. Use a 16-gauge catheter for rapid fluid administration.
Answer: B. Use a 22-gauge catheter to minimize trauma to fragile veins.
Rationale: Older adults often have fragile, rolling veins. Using a smaller gauge
catheter (22-24 gauge) minimizes trauma and reduces the risk of infiltration.
8. A nurse is preparing to insert a peripheral IV. Which of the following veins
should be avoided due to the risk of nerve damage?
A. Cephalic vein
B. Basilic vein
C. Median cubital vein
D. Dorsal venous arch
Answer: B. Basilic vein.
Rationale: The basilic vein is located near the brachial artery and median nerve. It
is typically the last choice for venipuncture due to the increased risk of nerve
injury.
9. A nurse is preparing to insert an IV in a client's forearm. After applying the
tourniquet, the vein is not prominent. Which of the following actions should the
nurse take?
A. Remove the tourniquet and apply a warm compress for 5-10 minutes.
B. Slap the vein to make it dilate.
C. Have the client dangle the arm below the heart.
D. Apply the tourniquet tighter.
, Answer: A. Remove the tourniquet and apply a warm compress for 5-10
minutes.
Rationale: Applying heat promotes vasodilation, making veins more prominent.
The tourniquet should be removed before applying heat to avoid prolonged
venous stasis. Slapping the vein is contraindicated.
10. A nurse is inserting a peripheral IV. The client reports a sharp, shooting pain
down the arm during insertion. Which of the following actions should the nurse
take?
A. Continue advancing the catheter and reassure the client.
B. Withdraw the needle immediately and apply pressure.
C. Flush the catheter with normal saline to check for patency.
D. Slightly withdraw the needle and redirect it.
Answer: B. Withdraw the needle immediately and apply pressure.
Rationale: Sharp, shooting pain radiating down the arm indicates possible nerve
puncture. The needle should be withdrawn immediately to prevent nerve
damage. Pressure should be applied to the site to stop any bleeding.
11. A nurse is preparing to insert an IV in a client with a history of mastectomy
on the right side. Which site is appropriate?
A. Right arm (same side as mastectomy)
B. Left arm (opposite side)
C. Dorsal veins of the right foot
D. External jugular vein
Answer: B. Left arm (opposite side).
Rationale: Venipuncture should be avoided on the arm ipsilateral (same side) to a
mastectomy due to the risk of lymphedema and compromised circulation.
12. A nurse is inserting an IV in a client's forearm. After inserting the catheter,
the nurse notes a slow blood return. Which of the following actions should the
nurse take?
A. Flush the catheter with 5 mL of normal saline and assess for swelling.
B. Remove the catheter and reattempt at a different site.
C. Advance the catheter further into the vein.
D. Connect the IV tubing and start the infusion.
