NURS 121L-B Medical-Surgical Nursing Practicum: IV Therapy, Infusion
Pumps & Fluid Management 2026 |WCU
1. A nurse is monitoring a patient receiving 0.45% normal saline. Which
physiological effect should the nurse anticipate as a result of this infusion?
A. Fluid shifts from the intracellular space to the extracellular space
B. Fluid shifts from the extracellular space into the cells
C. Fluid remains entirely within the intravascular compartment
D. Fluid shifts from the extracellular space into the cells
B. An increase in plasma oncotic pressure occurs
Answer: D
Rationale: 0.45% normal saline is a hypotonic solution, which has a lower osmolarity than
plasma, causing fluid to move into the cells to equalize concentration, potentially leading to
cellular swelling.
2. When assessing an IV site, the nurse notes coolness, pallor, and significant
swelling around the insertion site. The infusion has slowed. Which complication
is most likely?
A. Phlebitis
B. Thrombophlebitis
C. Infiltration
D. Extravasation
Answer: C
Rationale: Infiltration is characterized by the leakage of non-vesicant fluid into
surrounding tissue, presenting as coolness, pallor, and edema. Phlebitis would present with
warmth and redness.
,3. A patient is prescribed a high-concentration potassium chloride IV piggyback.
Which action is the absolute priority for safety?
A. Ensuring the infusion rate does not exceed 10 mEq/hour in a peripheral line
B. Administering the dose via IV push over 2 minutes
C. Restricting oral fluid intake during the infusion
D. Massaging the site to increase absorption speed
Answer: A
Rationale: Potassium must never be given IV push as it can cause cardiac arrest. The
standard safety limit for peripheral IV potassium is 10 mEq/hr to prevent vein irritation
and cardiotoxicity.
4. A patient is receiving Total Parenteral Nutrition (TPN) through a central line.
The nurse notices the bag is empty, and the next bag is not yet available from
the pharmacy. What is the most appropriate nursing action?
A. Cap the line and wait for the pharmacy to deliver the bag
B. Infuse 0.9% normal saline to maintain hydration
C. Slow the current rate to 5 mL/hr to keep the vein open
D. Infuse 10% dextrose in water (D10W) at the same rate
Answer: D
Rationale: TPN contains high concentrations of glucose. Abruptly stopping it can cause
rebound hypoglycemia. Infusing D10W at the same rate maintains blood glucose levels
until the next TPN bag arrives.
, 5. During the first 15 minutes of a packed red blood cell transfusion, the patient
reports chills, lower back pain, and dyspnea. What is the nurse’s first action?
A. Stop the infusion and disconnect the tubing at the hub
B. Administer diphenhydramine as ordered
C. Slow the infusion and notify the provider
D. Check the patient’s temperature and reassess in 10 minutes
Answer: A
Rationale: These are signs of a hemolytic transfusion reaction. The priority is to stop the
transfusion immediately and disconnect the tubing to prevent further exposure to the
incompatible blood.
6. A nurse is preparing to change a central venous access device (CVAD)
dressing. Which antiseptic is considered the gold standard for site disinfection?
A. 70% isopropyl alcohol
B. Chlorhexidine gluconate
C. Povidone-iodine
D. Hydrogen peroxide
Answer: B
Rationale: Chlorhexidine gluconate is the preferred antiseptic for CVAD site care due to its
long-lasting antimicrobial activity and efficacy in preventing CLABSIs.
7. Which clinical finding would most clearly indicate that a patient is
experiencing fluid volume excess?
A. A bounding pulse and crackles on lung auscultation
B. Increased hematocrit and hemoglobin
C. Flattened neck veins when supine
D. Poor skin turgor and dry mucous membranes
Answer: A
Pumps & Fluid Management 2026 |WCU
1. A nurse is monitoring a patient receiving 0.45% normal saline. Which
physiological effect should the nurse anticipate as a result of this infusion?
A. Fluid shifts from the intracellular space to the extracellular space
B. Fluid shifts from the extracellular space into the cells
C. Fluid remains entirely within the intravascular compartment
D. Fluid shifts from the extracellular space into the cells
B. An increase in plasma oncotic pressure occurs
Answer: D
Rationale: 0.45% normal saline is a hypotonic solution, which has a lower osmolarity than
plasma, causing fluid to move into the cells to equalize concentration, potentially leading to
cellular swelling.
2. When assessing an IV site, the nurse notes coolness, pallor, and significant
swelling around the insertion site. The infusion has slowed. Which complication
is most likely?
A. Phlebitis
B. Thrombophlebitis
C. Infiltration
D. Extravasation
Answer: C
Rationale: Infiltration is characterized by the leakage of non-vesicant fluid into
surrounding tissue, presenting as coolness, pallor, and edema. Phlebitis would present with
warmth and redness.
,3. A patient is prescribed a high-concentration potassium chloride IV piggyback.
Which action is the absolute priority for safety?
A. Ensuring the infusion rate does not exceed 10 mEq/hour in a peripheral line
B. Administering the dose via IV push over 2 minutes
C. Restricting oral fluid intake during the infusion
D. Massaging the site to increase absorption speed
Answer: A
Rationale: Potassium must never be given IV push as it can cause cardiac arrest. The
standard safety limit for peripheral IV potassium is 10 mEq/hr to prevent vein irritation
and cardiotoxicity.
4. A patient is receiving Total Parenteral Nutrition (TPN) through a central line.
The nurse notices the bag is empty, and the next bag is not yet available from
the pharmacy. What is the most appropriate nursing action?
A. Cap the line and wait for the pharmacy to deliver the bag
B. Infuse 0.9% normal saline to maintain hydration
C. Slow the current rate to 5 mL/hr to keep the vein open
D. Infuse 10% dextrose in water (D10W) at the same rate
Answer: D
Rationale: TPN contains high concentrations of glucose. Abruptly stopping it can cause
rebound hypoglycemia. Infusing D10W at the same rate maintains blood glucose levels
until the next TPN bag arrives.
, 5. During the first 15 minutes of a packed red blood cell transfusion, the patient
reports chills, lower back pain, and dyspnea. What is the nurse’s first action?
A. Stop the infusion and disconnect the tubing at the hub
B. Administer diphenhydramine as ordered
C. Slow the infusion and notify the provider
D. Check the patient’s temperature and reassess in 10 minutes
Answer: A
Rationale: These are signs of a hemolytic transfusion reaction. The priority is to stop the
transfusion immediately and disconnect the tubing to prevent further exposure to the
incompatible blood.
6. A nurse is preparing to change a central venous access device (CVAD)
dressing. Which antiseptic is considered the gold standard for site disinfection?
A. 70% isopropyl alcohol
B. Chlorhexidine gluconate
C. Povidone-iodine
D. Hydrogen peroxide
Answer: B
Rationale: Chlorhexidine gluconate is the preferred antiseptic for CVAD site care due to its
long-lasting antimicrobial activity and efficacy in preventing CLABSIs.
7. Which clinical finding would most clearly indicate that a patient is
experiencing fluid volume excess?
A. A bounding pulse and crackles on lung auscultation
B. Increased hematocrit and hemoglobin
C. Flattened neck veins when supine
D. Poor skin turgor and dry mucous membranes
Answer: A
