Infusion Therapy and Vascular Access Practice Exam
questions and correct answers– Updated 2026 (Graded
A+) instant download pdf
Subject: Advanced Nursing / Infusion Therapy
Subtopic: Professional Practice and Legal-Ethical Issues
Question 1: A nurse is assigned to initiate a short peripheral intravenous (IV) line on a
patient diagnosed with severe gastroenteritis. The patient is clear-minded and oriented but
adamantly refuses the procedure, stating they do not want any needles. Despite the
patient's refusal, the nurse proceeds to restrain the patient's arm and inserts the catheter.
Under civil law, which intentional tort has the nurse committed?
A) Negligence
B) Battery
C) Assault
D) Malpractice
Correct Answer: B - Battery Rationale: Battery is the intentional, unconsented, and harmful
or offensive touching of another person. Because the patient was competent and explicitly
refused the procedure, proceeding to insert the IV catheter constitutes battery. Assault
involves causing the apprehension of an imminent harmful contact, whereas negligence and
malpractice are unintentional torts involving a breach of the standard of care that results in
injury. ---
Question 2: A nurse manager is reviewing quality metrics for a clinical unit and notes a high
rate of peripheral IV-related complications. When evaluating the unit's adherence to
standards, which statement best characterizes the legal and clinical role of the Infusion
Nurses Society (INS) Infusion Therapy Standards of Practice?
A) They represent rigid statutory laws enacted by federal legislative bodies that carry
criminal penalties.
B) They provide a baseline for the minimum competent clinical performance expected of a
professional nurse.
C) They serve as suggestions that can be modified freely based on personal preference
without clinical documentation.
D) They are designed to focus exclusively on patient outcomes without defining specific
nursing behaviors.
Correct Answer: B - Provide a baseline for the minimum competent clinical performance
expected of a professional nurse. Rationale: Professional standards of practice, such as
,those published by the INS, define the scope and clinical expectations of competent nursing
care. In legal proceedings, these standards are utilized to establish the benchmark for the
standard of care to which a reasonably prudent nurse is held. They are not statutory laws,
but they hold significant legal weight in civil malpractice cases. ---
Subtopic: Infection Prevention and Occupational Risks
Question 3: While initiating a central venous access device (CVAD) dressing change, a
clinician uses chlorhexidine gluconate (CHG) with 70% isopropyl alcohol for skin antisepsis.
Which action best reflects evidence-based practice to maximize the antimicrobial efficacy of
the solution?
A) Applying the solution in a light circular motion starting from the periphery and moving
inward, then immediately covering with a dressing.
B) Using a vigorous back-and-forth friction rub for at least 30 seconds and allowing the site
to air-dry completely before dressing application.
C) Fan-drying the site vigorously for 10 seconds to expedite the evaporation process before
applying the securement device.
D) Applying a generous amount of solution and blotting the excess away with sterile gauze to
prevent skin maceration.
Correct Answer: B - Using a vigorous back-and-forth friction rub for at least 30 seconds and
allowing the site to air-dry completely before dressing application. Rationale: Current
evidence-based guidelines recommend a vigorous back-and-forth friction rub with CHG for at
least 30 seconds to penetrate the outer layers of the stratum corneum and target skin-
dwelling bacteria. Allowing the solution to air-dry completely is critical because the chemical
action continues during the drying phase, and trapping wet solution under a semipermeable
dressing can cause chemical dermatitis. ---
Question 4: A nurse is managing a patient with a peripheral intravenous catheter who
suddenly develops local erythema, warmth, and a palpable cord along the vein path. The
nurse documents a phlebitis score of 3. According to the INS standards, what is the most
appropriate immediate action?
A) Slow the infusion rate to half its current speed and apply a cold compress.
B) Flush the catheter with 10 mL of normal saline to check for patency and continue the
infusion.
C) Discontinue the peripheral IV catheter immediately, apply a warm compress, and select
an alternative site for a new line if therapy is still required.
D) Administer an intravenous bolus of an anti-inflammatory medication through the same
line to reduce endothelial irritation.
,Correct Answer: C - Discontinue the peripheral IV catheter immediately, apply a warm
compress, and select an alternative site for a new line if therapy is still required. Rationale:
A phlebitis score of 3 indicates erythema at the access site with pain, edema, and a palpable
venous cord. Any sign of symptomatic phlebitis warrants the immediate removal of the
offending catheter to prevent progression to thrombophlebitis or systemic infection. Warm
compresses promote circulation and localized healing. Flushing or continuing the infusion is
contraindicated. ---
Subtopic: Fundamentals of Fluid and Electrolyte Balance
Question 5: A patient with severe syndrome of inappropriate antidiuretic hormone (SIADH)
presents with an acute serum sodium level of $118 \text{ mEq/L}$ and signs of neurological
distress, including confusion and lethargy. The physician orders an infusion of 3% hypertonic
sodium chloride. Which pathophysiological fluid shift is expected following this
administration?
A) Water will shift from the intracellular fluid (ICF) compartment to the extracellular fluid
(ECF) compartment, shrinking brain cells.
B) Water will shift from the intravascular space into the interstitial space, worsening
peripheral edema.
C) Sodium ions will rapidly cross the blood-brain barrier to drive water into the cerebral cells,
causing intracellular swelling.
D) Solutes will diffuse out of the extracellular compartment into the lymphatic system to re-
establish isotonicity.
Correct Answer: A - Water will shift from the intracellular fluid (ICF) compartment to the
extracellular fluid (ECF) compartment, shrinking brain cells. Rationale: Hypertonic solutions
have a higher osmolarity than plasma ($>375 \text{ mOsm/L}$), creating an osmotic
gradient that draws water out of cells and into the hypertonic extracellular space. In severe
hyponatremia with cerebral edema, this shift reduces cellular swelling within brain tissues.
However, it must be monitored closely to avoid osmotic demyelination syndrome. ---
Question 6: A patient with advanced chronic kidney disease (CKD) presents with
electrocardiogram (ECG) changes including tall, peaked T-waves and a widened QRS
complex. The lab reports a serum potassium level of $6.8 \text{ mEq/L}$. Which intravenous
intervention should the nurse anticipate administering first to stabilize the cardiac
membrane?
A) Intravenous regular insulin and 50% dextrose bolus
B) Intravenous sodium bicarbonate infusion
C) Intravenous 10% calcium gluconate
, D) Intravenous furosemide bolus
Correct Answer: C - Intravenous 10% calcium gluconate Rationale: While insulin/dextrose
and sodium bicarbonate help shift potassium from the extracellular fluid into the cells, and
furosemide promotes renal excretion of potassium, they do not immediately protect the
heart. Calcium gluconate acts rapidly to stabilize the myocardial cell membrane by
normalizing the threshold potential, reducing the risk of lethal dysrhythmias in severe
hyperkalemia. ---
Subtopic: Infusion Fluid Administration and Parenteral Solutions
Question 7: A clinician is preparing to administer an intravenous solution with a documented
osmolarity of approximately $600 \text{ mOsm/L}$. Based on the pH and osmolarity limits
defined by evidence-based infusion standards, through which type of vascular access device
should this solution be infused?
A) A short peripheral intravenous catheter (22-gauge) in the cephalic vein.
B) A midline catheter terminating in the proximal axillary vein.
C) A central vascular access device (CVAD) with the tip terminating in the superior vena cava.
D) A standard 1.25-inch peripheral catheter in the dorsal venous network of the hand.
Correct Answer: C - A central vascular access device (CVAD) with the tip terminating in the
superior vena cava. Rationale: Infusion standards dictate that solutions with an osmolarity
greater than $900 \text{ mOsm/L}$ (and ideally those exceeding $500-600 \text{ mOsm/L}$
in pediatric or vulnerable populations) or chemical irritants/vesicants should be administered
through a central venous access device. Central veins feature rapid hemodilution (high blood
flow volumes), protecting the endothelial lining from chemical phlebitis and injury. ---
Question 8: A patient is prescribed a 5% Dextrose in 0.45% Sodium Chloride
($D_5\frac{1}{2}NS$) maintenance infusion. Which statement accurately describes the
tonicity of this solution upon initial container entry and its subsequent physiological
behavior inside the body?
A) It is hypotonic in the bag and remains hypotonic in the intravascular space.
B) It is hypertonic in the bag but acts as a hypotonic solution physiologically once dextrose is
metabolized.
C) It is isotonic in the bag and creates a sustained osmotic draw within the venous system.
D) It is hypertonic in the bag and remains hypertonic, drawing fluid continuously from the
cells.
Correct Answer: B - It is hypertonic in the bag but acts as a hypotonic solution
physiologically once dextrose is metabolized. Rationale: $D_5\frac{1}{2}NS$ has an
questions and correct answers– Updated 2026 (Graded
A+) instant download pdf
Subject: Advanced Nursing / Infusion Therapy
Subtopic: Professional Practice and Legal-Ethical Issues
Question 1: A nurse is assigned to initiate a short peripheral intravenous (IV) line on a
patient diagnosed with severe gastroenteritis. The patient is clear-minded and oriented but
adamantly refuses the procedure, stating they do not want any needles. Despite the
patient's refusal, the nurse proceeds to restrain the patient's arm and inserts the catheter.
Under civil law, which intentional tort has the nurse committed?
A) Negligence
B) Battery
C) Assault
D) Malpractice
Correct Answer: B - Battery Rationale: Battery is the intentional, unconsented, and harmful
or offensive touching of another person. Because the patient was competent and explicitly
refused the procedure, proceeding to insert the IV catheter constitutes battery. Assault
involves causing the apprehension of an imminent harmful contact, whereas negligence and
malpractice are unintentional torts involving a breach of the standard of care that results in
injury. ---
Question 2: A nurse manager is reviewing quality metrics for a clinical unit and notes a high
rate of peripheral IV-related complications. When evaluating the unit's adherence to
standards, which statement best characterizes the legal and clinical role of the Infusion
Nurses Society (INS) Infusion Therapy Standards of Practice?
A) They represent rigid statutory laws enacted by federal legislative bodies that carry
criminal penalties.
B) They provide a baseline for the minimum competent clinical performance expected of a
professional nurse.
C) They serve as suggestions that can be modified freely based on personal preference
without clinical documentation.
D) They are designed to focus exclusively on patient outcomes without defining specific
nursing behaviors.
Correct Answer: B - Provide a baseline for the minimum competent clinical performance
expected of a professional nurse. Rationale: Professional standards of practice, such as
,those published by the INS, define the scope and clinical expectations of competent nursing
care. In legal proceedings, these standards are utilized to establish the benchmark for the
standard of care to which a reasonably prudent nurse is held. They are not statutory laws,
but they hold significant legal weight in civil malpractice cases. ---
Subtopic: Infection Prevention and Occupational Risks
Question 3: While initiating a central venous access device (CVAD) dressing change, a
clinician uses chlorhexidine gluconate (CHG) with 70% isopropyl alcohol for skin antisepsis.
Which action best reflects evidence-based practice to maximize the antimicrobial efficacy of
the solution?
A) Applying the solution in a light circular motion starting from the periphery and moving
inward, then immediately covering with a dressing.
B) Using a vigorous back-and-forth friction rub for at least 30 seconds and allowing the site
to air-dry completely before dressing application.
C) Fan-drying the site vigorously for 10 seconds to expedite the evaporation process before
applying the securement device.
D) Applying a generous amount of solution and blotting the excess away with sterile gauze to
prevent skin maceration.
Correct Answer: B - Using a vigorous back-and-forth friction rub for at least 30 seconds and
allowing the site to air-dry completely before dressing application. Rationale: Current
evidence-based guidelines recommend a vigorous back-and-forth friction rub with CHG for at
least 30 seconds to penetrate the outer layers of the stratum corneum and target skin-
dwelling bacteria. Allowing the solution to air-dry completely is critical because the chemical
action continues during the drying phase, and trapping wet solution under a semipermeable
dressing can cause chemical dermatitis. ---
Question 4: A nurse is managing a patient with a peripheral intravenous catheter who
suddenly develops local erythema, warmth, and a palpable cord along the vein path. The
nurse documents a phlebitis score of 3. According to the INS standards, what is the most
appropriate immediate action?
A) Slow the infusion rate to half its current speed and apply a cold compress.
B) Flush the catheter with 10 mL of normal saline to check for patency and continue the
infusion.
C) Discontinue the peripheral IV catheter immediately, apply a warm compress, and select
an alternative site for a new line if therapy is still required.
D) Administer an intravenous bolus of an anti-inflammatory medication through the same
line to reduce endothelial irritation.
,Correct Answer: C - Discontinue the peripheral IV catheter immediately, apply a warm
compress, and select an alternative site for a new line if therapy is still required. Rationale:
A phlebitis score of 3 indicates erythema at the access site with pain, edema, and a palpable
venous cord. Any sign of symptomatic phlebitis warrants the immediate removal of the
offending catheter to prevent progression to thrombophlebitis or systemic infection. Warm
compresses promote circulation and localized healing. Flushing or continuing the infusion is
contraindicated. ---
Subtopic: Fundamentals of Fluid and Electrolyte Balance
Question 5: A patient with severe syndrome of inappropriate antidiuretic hormone (SIADH)
presents with an acute serum sodium level of $118 \text{ mEq/L}$ and signs of neurological
distress, including confusion and lethargy. The physician orders an infusion of 3% hypertonic
sodium chloride. Which pathophysiological fluid shift is expected following this
administration?
A) Water will shift from the intracellular fluid (ICF) compartment to the extracellular fluid
(ECF) compartment, shrinking brain cells.
B) Water will shift from the intravascular space into the interstitial space, worsening
peripheral edema.
C) Sodium ions will rapidly cross the blood-brain barrier to drive water into the cerebral cells,
causing intracellular swelling.
D) Solutes will diffuse out of the extracellular compartment into the lymphatic system to re-
establish isotonicity.
Correct Answer: A - Water will shift from the intracellular fluid (ICF) compartment to the
extracellular fluid (ECF) compartment, shrinking brain cells. Rationale: Hypertonic solutions
have a higher osmolarity than plasma ($>375 \text{ mOsm/L}$), creating an osmotic
gradient that draws water out of cells and into the hypertonic extracellular space. In severe
hyponatremia with cerebral edema, this shift reduces cellular swelling within brain tissues.
However, it must be monitored closely to avoid osmotic demyelination syndrome. ---
Question 6: A patient with advanced chronic kidney disease (CKD) presents with
electrocardiogram (ECG) changes including tall, peaked T-waves and a widened QRS
complex. The lab reports a serum potassium level of $6.8 \text{ mEq/L}$. Which intravenous
intervention should the nurse anticipate administering first to stabilize the cardiac
membrane?
A) Intravenous regular insulin and 50% dextrose bolus
B) Intravenous sodium bicarbonate infusion
C) Intravenous 10% calcium gluconate
, D) Intravenous furosemide bolus
Correct Answer: C - Intravenous 10% calcium gluconate Rationale: While insulin/dextrose
and sodium bicarbonate help shift potassium from the extracellular fluid into the cells, and
furosemide promotes renal excretion of potassium, they do not immediately protect the
heart. Calcium gluconate acts rapidly to stabilize the myocardial cell membrane by
normalizing the threshold potential, reducing the risk of lethal dysrhythmias in severe
hyperkalemia. ---
Subtopic: Infusion Fluid Administration and Parenteral Solutions
Question 7: A clinician is preparing to administer an intravenous solution with a documented
osmolarity of approximately $600 \text{ mOsm/L}$. Based on the pH and osmolarity limits
defined by evidence-based infusion standards, through which type of vascular access device
should this solution be infused?
A) A short peripheral intravenous catheter (22-gauge) in the cephalic vein.
B) A midline catheter terminating in the proximal axillary vein.
C) A central vascular access device (CVAD) with the tip terminating in the superior vena cava.
D) A standard 1.25-inch peripheral catheter in the dorsal venous network of the hand.
Correct Answer: C - A central vascular access device (CVAD) with the tip terminating in the
superior vena cava. Rationale: Infusion standards dictate that solutions with an osmolarity
greater than $900 \text{ mOsm/L}$ (and ideally those exceeding $500-600 \text{ mOsm/L}$
in pediatric or vulnerable populations) or chemical irritants/vesicants should be administered
through a central venous access device. Central veins feature rapid hemodilution (high blood
flow volumes), protecting the endothelial lining from chemical phlebitis and injury. ---
Question 8: A patient is prescribed a 5% Dextrose in 0.45% Sodium Chloride
($D_5\frac{1}{2}NS$) maintenance infusion. Which statement accurately describes the
tonicity of this solution upon initial container entry and its subsequent physiological
behavior inside the body?
A) It is hypotonic in the bag and remains hypotonic in the intravascular space.
B) It is hypertonic in the bag but acts as a hypotonic solution physiologically once dextrose is
metabolized.
C) It is isotonic in the bag and creates a sustained osmotic draw within the venous system.
D) It is hypertonic in the bag and remains hypertonic, drawing fluid continuously from the
cells.
Correct Answer: B - It is hypertonic in the bag but acts as a hypotonic solution
physiologically once dextrose is metabolized. Rationale: $D_5\frac{1}{2}NS$ has an
