IV Therapy Competency Exam — Code:
NUR-IV-COMP | 100-Question
Advanced Practice Exam 2026 |
Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1. A nurse is preparing to administer a vesicant through a peripheral IV.
Before administration, which assessment is the highest priority?
A. Confirm the patient's allergy history
B. Assess the IV site for blood return, patency, and signs of infiltration
C. Check the patient's most recent blood pressure
D. Flush the IV with sterile water
Answer: Assess the IV site for blood return, patency, and signs of infiltration
Rationale: A vesicant can cause severe tissue injury if it infiltrates. The nurse
should verify patency and obtain appropriate blood return according to the
medication and institutional protocol before administration.
, 2. A patient receiving a continuous IV infusion suddenly reports burning and
tightness at the catheter site. The nurse notes swelling around the insertion
site. What is the nurse's priority action?
A. Increase the infusion rate
B. Apply pressure and continue the infusion
C. Stop the infusion immediately
D. Reposition the extremity and reassess in 30 minutes
Answer: Stop the infusion immediately
Rationale: Burning, tightness, and swelling are consistent with IV infiltration or
extravasation. The infusion must be stopped promptly to prevent additional
tissue injury.
3. A peripheral IV site is cool, pale, swollen, and uncomfortable. Which
complication is most likely?
A. Phlebitis
B. Infiltration
C. Hematoma
D. Local infection
Answer: Infiltration
Rationale: Infiltration occurs when a nonvesicant solution escapes into
surrounding tissue, commonly causing coolness, pallor, swelling, and discomfort.
4. Which finding most strongly suggests phlebitis rather than infiltration?
A. Coolness and blanching
B. Edema without tenderness
C. Warmth, erythema, tenderness, and a palpable venous cord
D. Leakage of clear fluid around the catheter
Answer: Warmth, erythema, tenderness, and a palpable venous cord
,Rationale: Phlebitis is inflammation of the vein and commonly produces
warmth, redness, tenderness, and a palpable cord along the vein.
5. A nurse is selecting a peripheral IV catheter for rapid administration of a
large volume of isotonic fluid in an unstable adult patient. Which catheter is
generally most appropriate?
A. 24-gauge
B. 22-gauge
C. 20-gauge
D. 18-gauge
Answer: 18-gauge
Rationale: A larger-bore catheter provides greater flow and is commonly
preferred when rapid fluid administration is required in adults, provided the
patient's veins can accommodate it.
6. Which action best reduces the risk of catheter-related infection during
peripheral IV insertion?
A. Palpating the prepared site repeatedly
B. Maintaining aseptic technique and allowing the antiseptic to dry appropriately
C. Blowing on the site to accelerate drying
D. Reusing the same antiseptic applicator
Answer: Maintaining aseptic technique and allowing the antiseptic to dry
appropriately
Rationale: Proper skin antisepsis, hand hygiene, aseptic technique, and allowing
the antiseptic to dry reduce microbial contamination and infection risk.
7. During IV insertion, the nurse obtains a flash of blood but cannot advance
the catheter. What is the best action?
A. Force the catheter forward
B. Withdraw the needle slightly and attempt to redirect the catheter without
advancing the needle
, C. Advance the needle farther into the vein
D. Remove the catheter and reinsert the same catheter at another angle
Answer: Withdraw the needle slightly and attempt to redirect the catheter
without advancing the needle
Rationale: Once the needle has entered the vein, advancing the needle can
puncture the posterior wall. The catheter should be advanced appropriately
without forcing it. A failed attempt requires a new sterile catheter.
8. A patient has fragile veins and requires short-term peripheral IV therapy.
Which approach is most appropriate?
A. Use the largest catheter possible regardless of vein size
B. Select the smallest appropriate gauge and minimize tourniquet pressure
C. Apply prolonged vigorous pressure to the vein
D. Insert the catheter through an area of bruising
Answer: Select the smallest appropriate gauge and minimize tourniquet
pressure
Rationale: Smaller appropriate catheters and gentle technique help preserve
fragile veins and reduce trauma.
9. A nurse notes a localized area of redness and drainage at a peripheral IV
insertion site. What should the nurse suspect?
A. Normal venous response
B. Catheter-related infection
C. Fluid overload
D. Infiltration only
Answer: Catheter-related infection
Rationale: Erythema accompanied by drainage is concerning for infection and
requires prompt assessment and appropriate intervention.
10.Which patient has the greatest risk for fluid overload during IV therapy?
NUR-IV-COMP | 100-Question
Advanced Practice Exam 2026 |
Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1. A nurse is preparing to administer a vesicant through a peripheral IV.
Before administration, which assessment is the highest priority?
A. Confirm the patient's allergy history
B. Assess the IV site for blood return, patency, and signs of infiltration
C. Check the patient's most recent blood pressure
D. Flush the IV with sterile water
Answer: Assess the IV site for blood return, patency, and signs of infiltration
Rationale: A vesicant can cause severe tissue injury if it infiltrates. The nurse
should verify patency and obtain appropriate blood return according to the
medication and institutional protocol before administration.
, 2. A patient receiving a continuous IV infusion suddenly reports burning and
tightness at the catheter site. The nurse notes swelling around the insertion
site. What is the nurse's priority action?
A. Increase the infusion rate
B. Apply pressure and continue the infusion
C. Stop the infusion immediately
D. Reposition the extremity and reassess in 30 minutes
Answer: Stop the infusion immediately
Rationale: Burning, tightness, and swelling are consistent with IV infiltration or
extravasation. The infusion must be stopped promptly to prevent additional
tissue injury.
3. A peripheral IV site is cool, pale, swollen, and uncomfortable. Which
complication is most likely?
A. Phlebitis
B. Infiltration
C. Hematoma
D. Local infection
Answer: Infiltration
Rationale: Infiltration occurs when a nonvesicant solution escapes into
surrounding tissue, commonly causing coolness, pallor, swelling, and discomfort.
4. Which finding most strongly suggests phlebitis rather than infiltration?
A. Coolness and blanching
B. Edema without tenderness
C. Warmth, erythema, tenderness, and a palpable venous cord
D. Leakage of clear fluid around the catheter
Answer: Warmth, erythema, tenderness, and a palpable venous cord
,Rationale: Phlebitis is inflammation of the vein and commonly produces
warmth, redness, tenderness, and a palpable cord along the vein.
5. A nurse is selecting a peripheral IV catheter for rapid administration of a
large volume of isotonic fluid in an unstable adult patient. Which catheter is
generally most appropriate?
A. 24-gauge
B. 22-gauge
C. 20-gauge
D. 18-gauge
Answer: 18-gauge
Rationale: A larger-bore catheter provides greater flow and is commonly
preferred when rapid fluid administration is required in adults, provided the
patient's veins can accommodate it.
6. Which action best reduces the risk of catheter-related infection during
peripheral IV insertion?
A. Palpating the prepared site repeatedly
B. Maintaining aseptic technique and allowing the antiseptic to dry appropriately
C. Blowing on the site to accelerate drying
D. Reusing the same antiseptic applicator
Answer: Maintaining aseptic technique and allowing the antiseptic to dry
appropriately
Rationale: Proper skin antisepsis, hand hygiene, aseptic technique, and allowing
the antiseptic to dry reduce microbial contamination and infection risk.
7. During IV insertion, the nurse obtains a flash of blood but cannot advance
the catheter. What is the best action?
A. Force the catheter forward
B. Withdraw the needle slightly and attempt to redirect the catheter without
advancing the needle
, C. Advance the needle farther into the vein
D. Remove the catheter and reinsert the same catheter at another angle
Answer: Withdraw the needle slightly and attempt to redirect the catheter
without advancing the needle
Rationale: Once the needle has entered the vein, advancing the needle can
puncture the posterior wall. The catheter should be advanced appropriately
without forcing it. A failed attempt requires a new sterile catheter.
8. A patient has fragile veins and requires short-term peripheral IV therapy.
Which approach is most appropriate?
A. Use the largest catheter possible regardless of vein size
B. Select the smallest appropriate gauge and minimize tourniquet pressure
C. Apply prolonged vigorous pressure to the vein
D. Insert the catheter through an area of bruising
Answer: Select the smallest appropriate gauge and minimize tourniquet
pressure
Rationale: Smaller appropriate catheters and gentle technique help preserve
fragile veins and reduce trauma.
9. A nurse notes a localized area of redness and drainage at a peripheral IV
insertion site. What should the nurse suspect?
A. Normal venous response
B. Catheter-related infection
C. Fluid overload
D. Infiltration only
Answer: Catheter-related infection
Rationale: Erythema accompanied by drainage is concerning for infection and
requires prompt assessment and appropriate intervention.
10.Which patient has the greatest risk for fluid overload during IV therapy?
