1
HESI Fluid Resuscitation & IV Med
Calculations Master Guide (NGN-
Ready)
Table of Contents
Subtopic 1: Principles of Fluid Resuscitation in Acute and Critical Care
Settings............................................................................................................2
Subtopic 2: IV Fluid Types and Clinical Indications.........................................10
Subtopic 3: IV Fluid Rate Calculations and Drip Factors.................................19
Subtopic 5: Pediatric and Geriatric Considerations in Fluid and IV Therapy. .35
Subtopic 6: Managing Electrolyte Imbalances During Fluid Therapy.............44
Subtopic 7: IV Compatibility, Mixing, and Drug Interactions..........................53
Subtopic 8: Pediatric and Geriatric Considerations in IV Therapy..................61
Subtopic 9: Blood Transfusion and Volume Expanders in IV Therapy.............70
Subtopic 10: Documentation, Legal Considerations, and Best Practices in IV
Therapy..........................................................................................................79
, 2
Subtopic 1: Principles of Fluid Resuscitation in
Acute and Critical Care Settings
Question 1
A patient with sepsis is being treated with aggressive fluid resuscitation.
What is the most appropriate initial fluid choice?
A. 0.45% Normal Saline
B. 0.9% Normal Saline
C. D5W
D. Lactulose
Correct Answer: B. 0.9% Normal Saline
Rationale: Isotonic crystalloids such as 0.9% Normal Saline are the first-line
fluids for resuscitation in sepsis to restore intravascular volume.
Question 2
Which clinical indicator best reflects the effectiveness of fluid resuscitation in
a hypotensive trauma patient?
A. Increased serum creatinine
B. Decreased hemoglobin
C. Improved blood pressure and urine output
D. Decreased respiratory rate
Correct Answer: C. Improved blood pressure and urine output
Rationale: Restoration of hemodynamic stability and perfusion is best
assessed by improved blood pressure and urine output.
Question 3
, 3
A patient is receiving a bolus of 500 mL Lactated Ringer’s. Which condition
requires cautious use of this fluid?
A. Diarrhea
B. Liver failure
C. Dehydration
D. Sepsis
Correct Answer: B. Liver failure
Rationale: Lactated Ringer's contains lactate, which is metabolized by the
liver; impaired metabolism in liver failure may worsen lactic acidosis.
Question 4
A nurse is preparing to give a 30 mL/kg fluid bolus to a 70 kg septic patient.
How much fluid should be administered?
A. 1000 mL
B. 1500 mL
C. 2100 mL
D. 2500 mL
Correct Answer: C. 2100 mL
Rationale: 30 mL × 70 kg = 2100 mL. The Surviving Sepsis Campaign
recommends 30 mL/kg crystalloid for initial fluid resuscitation.
Question 5
Which of the following best describes the purpose of fluid resuscitation in
hypovolemic shock?
A. Increase blood viscosity
B. Restore tissue perfusion
, 4
C. Reduce inflammation
D. Correct hyperkalemia
Correct Answer: B. Restore tissue perfusion
Rationale: The primary goal is to increase intravascular volume and oxygen
delivery to tissues.
Question 6
Which vital sign change suggests the need to slow fluid resuscitation?
A. New onset crackles and decreased oxygen saturation
B. Decreased heart rate
C. Increased urine output
D. Increased capillary refill
Correct Answer: A. New onset crackles and decreased oxygen saturation
Rationale: These may indicate pulmonary edema and fluid overload,
requiring adjustment of fluid rate.
Question 7
Which laboratory value is most important to monitor during aggressive fluid
resuscitation for dehydration?
A. Hemoglobin
B. Serum sodium
C. WBC count
D. Bilirubin
Correct Answer: B. Serum sodium
HESI Fluid Resuscitation & IV Med
Calculations Master Guide (NGN-
Ready)
Table of Contents
Subtopic 1: Principles of Fluid Resuscitation in Acute and Critical Care
Settings............................................................................................................2
Subtopic 2: IV Fluid Types and Clinical Indications.........................................10
Subtopic 3: IV Fluid Rate Calculations and Drip Factors.................................19
Subtopic 5: Pediatric and Geriatric Considerations in Fluid and IV Therapy. .35
Subtopic 6: Managing Electrolyte Imbalances During Fluid Therapy.............44
Subtopic 7: IV Compatibility, Mixing, and Drug Interactions..........................53
Subtopic 8: Pediatric and Geriatric Considerations in IV Therapy..................61
Subtopic 9: Blood Transfusion and Volume Expanders in IV Therapy.............70
Subtopic 10: Documentation, Legal Considerations, and Best Practices in IV
Therapy..........................................................................................................79
, 2
Subtopic 1: Principles of Fluid Resuscitation in
Acute and Critical Care Settings
Question 1
A patient with sepsis is being treated with aggressive fluid resuscitation.
What is the most appropriate initial fluid choice?
A. 0.45% Normal Saline
B. 0.9% Normal Saline
C. D5W
D. Lactulose
Correct Answer: B. 0.9% Normal Saline
Rationale: Isotonic crystalloids such as 0.9% Normal Saline are the first-line
fluids for resuscitation in sepsis to restore intravascular volume.
Question 2
Which clinical indicator best reflects the effectiveness of fluid resuscitation in
a hypotensive trauma patient?
A. Increased serum creatinine
B. Decreased hemoglobin
C. Improved blood pressure and urine output
D. Decreased respiratory rate
Correct Answer: C. Improved blood pressure and urine output
Rationale: Restoration of hemodynamic stability and perfusion is best
assessed by improved blood pressure and urine output.
Question 3
, 3
A patient is receiving a bolus of 500 mL Lactated Ringer’s. Which condition
requires cautious use of this fluid?
A. Diarrhea
B. Liver failure
C. Dehydration
D. Sepsis
Correct Answer: B. Liver failure
Rationale: Lactated Ringer's contains lactate, which is metabolized by the
liver; impaired metabolism in liver failure may worsen lactic acidosis.
Question 4
A nurse is preparing to give a 30 mL/kg fluid bolus to a 70 kg septic patient.
How much fluid should be administered?
A. 1000 mL
B. 1500 mL
C. 2100 mL
D. 2500 mL
Correct Answer: C. 2100 mL
Rationale: 30 mL × 70 kg = 2100 mL. The Surviving Sepsis Campaign
recommends 30 mL/kg crystalloid for initial fluid resuscitation.
Question 5
Which of the following best describes the purpose of fluid resuscitation in
hypovolemic shock?
A. Increase blood viscosity
B. Restore tissue perfusion
, 4
C. Reduce inflammation
D. Correct hyperkalemia
Correct Answer: B. Restore tissue perfusion
Rationale: The primary goal is to increase intravascular volume and oxygen
delivery to tissues.
Question 6
Which vital sign change suggests the need to slow fluid resuscitation?
A. New onset crackles and decreased oxygen saturation
B. Decreased heart rate
C. Increased urine output
D. Increased capillary refill
Correct Answer: A. New onset crackles and decreased oxygen saturation
Rationale: These may indicate pulmonary edema and fluid overload,
requiring adjustment of fluid rate.
Question 7
Which laboratory value is most important to monitor during aggressive fluid
resuscitation for dehydration?
A. Hemoglobin
B. Serum sodium
C. WBC count
D. Bilirubin
Correct Answer: B. Serum sodium
