IV Therapy and Fluid Management Flashcards

A client's IV site is red, warm, painful, and has a palpable cord along the vein. The LPN should document this as:

Answer: Phlebitis

Redness, warmth, pain, and a palpable cord along a vein are classic signs of phlebitis — inflammation of the vein wall, a common IV complication.

A client receiving IV vancomycin develops flushing, erythema, and pruritus on the face and neck during the infusion. The LPN recognizes this as:

Answer: Red Man Syndrome — an infusion-rate reaction requiring slowing the infusion

Red Man Syndrome is a non-immune, infusion-rate-dependent reaction to vancomycin causing histamine release. It is treated by slowing the infusion, not stopping it, and may be prevented with diphenhydramine.

The LPN is calculating an IV flow rate. An order reads: Infuse 1,000 mL 0.9% NaCl over 8 hours. The drip factor is 20 gtts/mL. What is the correct flow rate in gtts/min?

Answer: 42 gtts/min

Formula: Volume (mL) ÷ Time (min) × Drip factor = 1000 ÷ 480 × 20 = 41.7 ≈ 42 gtts/min.

A client is receiving a blood transfusion. After 15 minutes, the client develops a temperature of 38.7°C (101.7°F), chills, and back pain. The LPN's first action is:

Answer: Stop the transfusion immediately, keep the IV line open with normal saline, and notify the charge nurse

Fever, chills, and back pain during a transfusion suggest an acute hemolytic reaction (ABO incompatibility). The transfusion must be stopped immediately, the line kept open with NS, and the charge nurse notified.

A client has a peripheral IV infusing. The nurse notices the infusion site is cool, pale, puffy, and non-painful. The LPN documents this as:

Answer: Infiltration

Coolness, pallor, swelling, and absence of pain at an IV site indicate infiltration — IV fluid leaking into the subcutaneous tissue from a displaced or perforated catheter.

A client is prescribed D5W (5% dextrose in water) 500 mL IV. The LPN understands this solution is classified as:

Answer: Isotonic in the bag, but becomes hypotonic once infused as the dextrose is metabolized

D5W is technically isotonic in the bag (308 mOsm/L), but once dextrose is metabolized by cells, it effectively becomes free water (hypotonic), distributing into all body compartments.

The LPN is flushing a client's intermittent IV access device (saline lock) before medication administration. The appropriate flushing technique is:

Answer: Flush with 3–5 mL normal saline, administer medication, then flush with 3–5 mL normal saline (SASH if heparin ordered)

The SASH technique (Saline-Administer medication-Saline-Heparin) or SAL (without heparin) ensures catheter patency and prevents drug incompatibilities. Normal saline is the standard flush solution.

A client with heart failure is receiving IV fluids ordered at 250 mL/hr. Two hours into the infusion, the client develops worsening dyspnea and oxygen saturation drops from 98% to 91%. The LPN should:

Answer: Slow the IV infusion, sit the client upright, apply oxygen, and immediately notify the charge nurse

Worsening dyspnea and oxygen desaturation during IV fluid therapy in a heart failure client indicate fluid volume overload and developing pulmonary edema — a medical emergency requiring immediate intervention.

A client requires a central venous catheter (CVC) insertion. Which position and preparation reduces air embolism risk during insertion?

Answer: Place in Trendelenburg position (head lower than feet) and have the client hold breath during insertion

Trendelenburg position increases central venous pressure, distending the vein for easier access and reducing the risk of air entering the catheter during insertion by raising venous pressure above atmospheric.

A client is receiving potassium chloride (KCl) 40 mEq IV. The LPN knows that this infusion must:

Answer: Never exceed a rate of 10–20 mEq/hour for peripheral IV infusion

IV potassium must never be given as a bolus (can cause fatal cardiac arrest) and peripheral infusion must not exceed 10 mEq/hr to prevent venous irritation and cardiac toxicity.

A client receiving a continuous IV heparin infusion develops petechiae, nosebleed, and oozing from the venipuncture site. The LPN should:

Answer: Immediately stop the heparin infusion and notify the charge nurse

Signs of bleeding complications from heparin therapy require immediate discontinuation of the infusion and urgent notification, not continuation while applying pressure.

A client has a PICC (peripherally inserted central catheter) line. The nurse notes the catheter appears to have pulled out approximately 2 cm since insertion. The LPN should:

Answer: Do not use the line — notify the charge nurse and anticipate repositioning confirmation

A PICC line that has migrated must not be used for infusion until catheter position is confirmed by X-ray. Never advance a catheter that has partially withdrawn — it is now contaminated.

A client receiving IV amiodarone through a peripheral IV develops severe pain and a burning sensation at the infusion site. The skin around the site is blistering. The LPN should immediately:

Answer: Stop the infusion and notify the charge nurse — amiodarone is a vesicant causing extravasation injury

Amiodarone is a vesicant — it causes tissue necrosis when extravasated. Blistering indicates tissue damage. Stop the infusion immediately and escalate to the charge nurse for vesicant extravasation protocol.

A client with a serum sodium of 120 mEq/L (normal 135–145 mEq/L) is receiving hypertonic saline (3% NaCl). Which complication is most important to monitor for?

Answer: Osmotic demyelination syndrome from correcting sodium too rapidly

Rapidly correcting severe hyponatremia with hypertonic saline can cause osmotic demyelination syndrome (central pontine myelinolysis), causing permanent neurological damage or death.

A nurse is preparing to administer an IV infusion to a child weighing 22 kg. The order reads 0.9% NaCl at maintenance rate. Using the Holliday-Segar method, the maintenance fluid rate is:

Answer: 62 mL/hr

Holliday-Segar: 100 mL/kg for first 10 kg (=1000) + 50 mL/kg for next 10 kg (=500) + 20 mL/kg for remaining 2 kg (=40). Total = 1540 mL/24hr ÷ 24 = 64.2 ≈ 62–65 mL/hr.

A client with a peripherally inserted IV catheter has not been infusing for 4 hours. Before resuming the infusion, the LPN should:

Answer: Assess the site, flush with normal saline to verify patency, and check for blood return in peripheral IV before restarting

Before resuming any IV infusion, the LPN must assess the site and flush to verify patency. Blood return confirms catheter is in the vein, not in subcutaneous tissue.

A client is admitted with dehydration. Assessment findings include dry mucous membranes, poor skin turgor, urine output of 20 mL/hr, and serum sodium of 148 mEq/L. The LPN anticipates which IV fluid will be ordered?

Answer: 0.45% NaCl (half-normal saline) — hypotonic fluid to replace free water deficit

A serum sodium of 148 mEq/L indicates hypernatremia from free water deficit. Hypotonic solution (0.45% NaCl) is used to replace free water and gradually correct hypernatremia.

During a blood transfusion, the client develops urticaria (hives) on the trunk and arms but no respiratory symptoms or hemodynamic changes. The LPN should:

Answer: Slow or temporarily stop the transfusion, administer diphenhydramine per order, and resume after symptoms resolve

Urticaria during a transfusion indicates a mild allergic reaction. The standard management is to slow or temporarily stop the transfusion, administer an antihistamine, and resume at a slower rate after symptoms resolve.

A client receiving normal saline develops a temperature of 40°C (104°F), severe shaking chills, hypotension, and tachycardia within minutes of starting the IV infusion. The LPN suspects:

Answer: Septic reaction from a contaminated IV solution

High fever, rigors, and septic shock signs immediately after starting an IV (even with saline) indicate a septic reaction from a contaminated solution — a life-threatening emergency.

The LPN is changing a central line dressing. Which technique is most important to prevent catheter-related bloodstream infection (CRBSI)?

Answer: Use sterile gloves and maximum barrier precautions with chlorhexidine skin antisepsis

CRBSI prevention requires maximum sterile barrier precautions (sterile gloves, mask, cap, gown, large sterile drape) and chlorhexidine-based skin antisepsis — the gold standard per CDC guidelines.