NURS 358 Final Exam Questions With
Solutions Graded A+.
Types of Isotonic IV solutions - Answer Normal Saline (0.9% NS)
5% Dextrose in Water (D5W)
Lactated Ringers (LR) contains sodium, potassium, chloride, calcium, and lactate
How do Isotonic IV solutions work? - Answer expands the ECF, same osmolarity as serum
Types of Hypotonic IV solutions - Answer One-half normal saline (0.45% NS)
5% dextrose in water (D5W) listed as isotonic but becomes hypertonic as sugar (dextrose
quickly metabolized leaving water)
How do Hypotonic IV solutions work? - Answer osmosis from ECF to ICF (from serum back into
cell, trying to hydrate cells)
Types of Hypertonic solutions - Answer Dextrose 5% in normal saline (D5NS)
Dextrose 5% in one-half normal saline (D5 1/2 NS)
How do Hypertonic IV solutions work? - Answer raises osmolarity of ECF (needs more fluid)
Also draws water out of cells into ECF
Used to perfuse all organs, make sure patient does not go into kidney failure after surgery, etc.
Can you use hypotonic solutions when a person has a head injury? Why? - Answer No, do not
want to pull more fluid into the cranium
Assessments to perform when initating an IV - Answer • Medical history; dehydration
• Age, size, weight, fitness
• Condition of veins
• Type fluid/meds.
oMeds that run continuously may be hard on the vein
• Duration of therapy-possible central line
, • Check radial pulse
• May palpate vein above insertion site but not on insertion site (once scrubbed, don't touch it)
Why should the IV solution be mixed when adding medication to a continuous infusion? -
Answer • Medications should be mixed because they need to be compatible before infusing
o Decreases the risk for side effects
o Diluted in large volumes of compatible IV fluids such as normal saline or lactated Ringer's
solution
• Some medications may be hard on the veins, that is why you dilute with NS
What size of IV catheter should be used? - Answer • Use smallest diameter in largest vein
possible (higher the number, the smaller the diameter)
o 22-26 gauge in children and elderly
o 20-24 gauge medical and post-op patients-usually red color
o 18 gauge for surgical and blood infusion-larger catheter, usually green color
o 14-16 gauge for trauma-Need access, large catheter, large diameter for fluids to be pumped
rapidly
Areas to avoid when inserting a new IV? - Answer o Anti-cubital because we bend our arm a
lot
o Hand and wrist because of so many nerves
o Scar tissue
o Open areas
o Bruising
o Veins below a previous site
o Arm that may be utilized for a fistula or shunt
o Patients with mastectomy or removal of lymph nodes
If pumping fluids into arm and lymph nodes aren't there, there will be issues
o Areas of edema
What is infiltration? - Answer fluids leak into surrounding tissue (especially if the vein stops
working)
Solutions Graded A+.
Types of Isotonic IV solutions - Answer Normal Saline (0.9% NS)
5% Dextrose in Water (D5W)
Lactated Ringers (LR) contains sodium, potassium, chloride, calcium, and lactate
How do Isotonic IV solutions work? - Answer expands the ECF, same osmolarity as serum
Types of Hypotonic IV solutions - Answer One-half normal saline (0.45% NS)
5% dextrose in water (D5W) listed as isotonic but becomes hypertonic as sugar (dextrose
quickly metabolized leaving water)
How do Hypotonic IV solutions work? - Answer osmosis from ECF to ICF (from serum back into
cell, trying to hydrate cells)
Types of Hypertonic solutions - Answer Dextrose 5% in normal saline (D5NS)
Dextrose 5% in one-half normal saline (D5 1/2 NS)
How do Hypertonic IV solutions work? - Answer raises osmolarity of ECF (needs more fluid)
Also draws water out of cells into ECF
Used to perfuse all organs, make sure patient does not go into kidney failure after surgery, etc.
Can you use hypotonic solutions when a person has a head injury? Why? - Answer No, do not
want to pull more fluid into the cranium
Assessments to perform when initating an IV - Answer • Medical history; dehydration
• Age, size, weight, fitness
• Condition of veins
• Type fluid/meds.
oMeds that run continuously may be hard on the vein
• Duration of therapy-possible central line
, • Check radial pulse
• May palpate vein above insertion site but not on insertion site (once scrubbed, don't touch it)
Why should the IV solution be mixed when adding medication to a continuous infusion? -
Answer • Medications should be mixed because they need to be compatible before infusing
o Decreases the risk for side effects
o Diluted in large volumes of compatible IV fluids such as normal saline or lactated Ringer's
solution
• Some medications may be hard on the veins, that is why you dilute with NS
What size of IV catheter should be used? - Answer • Use smallest diameter in largest vein
possible (higher the number, the smaller the diameter)
o 22-26 gauge in children and elderly
o 20-24 gauge medical and post-op patients-usually red color
o 18 gauge for surgical and blood infusion-larger catheter, usually green color
o 14-16 gauge for trauma-Need access, large catheter, large diameter for fluids to be pumped
rapidly
Areas to avoid when inserting a new IV? - Answer o Anti-cubital because we bend our arm a
lot
o Hand and wrist because of so many nerves
o Scar tissue
o Open areas
o Bruising
o Veins below a previous site
o Arm that may be utilized for a fistula or shunt
o Patients with mastectomy or removal of lymph nodes
If pumping fluids into arm and lymph nodes aren't there, there will be issues
o Areas of edema
What is infiltration? - Answer fluids leak into surrounding tissue (especially if the vein stops
working)
