IV Access and Fluids Practice Questions

83 multiple-choice questions on IV access and fluids for paramedic and EMT students, from Chapter 14 (Medication Administration). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

83 practice questions

1. The primary purpose of IV access in EMS is to:

   1. A. Monitor central venous pressure
   2. B. Draw blood samples for labs
   3. C. A route for fluids and drugs
   4. D. Meet documentation requirements
   Show answer

   Answer: C. A route for fluids and drugs

   Establish it when there is a reasonable expectation it will be needed.

2. For rapid fluid resuscitation in an adult, the preferred catheter is:

   1. A. 14 or 16 gauge
   2. B. 24 or 26 gauge
   3. C. 22 or 24 gauge
   4. D. 20 or 22 gauge
   Show answer

   Answer: A. 14 or 16 gauge

   Flow depends on catheter diameter and length.

3. The preferred initial site for peripheral IV access is usually the:

   1. A. External jugular vein
   2. B. Hand veins in all patients
   3. C. Forearm or antecubital veins
   4. D. Saphenous vein of the ankle
   Show answer

   Answer: C. Forearm or antecubital veins

   Choose the largest suitable vein distal enough to allow later attempts above it.

4. A tourniquet applied for IV access should be:

   1. A. Left on at least 5 minutes
   2. B. Left on for the entire infusion
   3. C. Placed directly over the site
   4. D. Released once the catheter is in
   Show answer

   Answer: D. Released once the catheter is in

   Prolonged application causes discomfort and affects blood samples. Release it once the catheter is placed and flow is confirmed.

5. Infiltration occurs when:

   1. A. The catheter tip breaks off in the vein
   2. B. Air enters the venous system through it
   3. C. Fluid leaks into surrounding tissue
   4. D. The vein wall itself becomes inflamed
   Show answer

   Answer: C. Fluid leaks into surrounding tissue

   Swelling, coolness, and pain at the site suggest it; stop the infusion.

6. Phlebitis is characterized by:

   1. A. Swelling and cool, pale skin
   2. B. Bleeding around the catheter
   3. C. Redness, warmth, and a tender vein
   4. D. Air bubbles in the tubing
   Show answer

   Answer: C. Redness, warmth, and a tender vein

   Discontinue the line and consider a new site. A palpable cord along the vein is common.

7. Catheter shear embolism occurs when:

   1. A. Air is drawn into the line
   2. B. The tourniquet is left on too long
   3. C. The vein ruptures on insertion
   4. D. The needle cuts a catheter fragment
   Show answer

   Answer: D. The needle cuts a catheter fragment

   Never reinsert the needle into a catheter that has been advanced. This happens when the catheter is withdrawn back over the needle.

8. Air embolism is prevented by:

   1. A. Using a large-bore catheter
   2. B. Using a pressure infuser bag
   3. C. Elevating the IV bag higher
   4. D. Fully priming the tubing
   Show answer

   Answer: D. Fully priming the tubing

   Significant volumes are needed to cause harm, but prevention is simple. Also keep all connections tight.

9. A saline lock is used when:

   1. A. Blood will be transfused
   2. B. Continuous fluid is needed
   3. C. Access is needed without fluids
   4. D. A pressure infusion is planned
   Show answer

   Answer: C. Access is needed without fluids

   Flush it to confirm patency before administering medications.

10. Normal saline and lactated Ringer's are:

    1. A. Hypertonic solutions
    2. B. Isotonic crystalloids
    3. C. Hypotonic solutions
    4. D. Colloid solutions
    Show answer

    Answer: B. Isotonic crystalloids

    They expand intravascular volume temporarily. They remain mostly extracellular.

11. Dextrose 5 percent in water is best described as:

    1. A. Effectively hypotonic once metabolized
    2. B. A colloid that stays intravascular
    3. C. An isotonic volume expander
    4. D. A hypertonic resuscitation fluid
    Show answer

    Answer: A. Effectively hypotonic once metabolized

    It is not used for volume resuscitation.

12. A colloid solution differs from a crystalloid because it:

    1. A. Is always hypotonic to plasma
    2. B. Holds fluid in vessels longer
    3. C. Shifts fluid into the cells
    4. D. Contains only electrolytes
    Show answer

    Answer: B. Holds fluid in vessels longer

    Albumin and hetastarch are examples. Its large molecules keep fluid in the intravascular space.

13. A macrodrip administration set typically delivers:

    1. A. 45 or 60 gtt/mL
    2. B. 10 or 15 gtt/mL
    3. C. 100 gtt/mL
    4. D. 1 or 5 gtt/mL
    Show answer

    Answer: B. 10 or 15 gtt/mL

    Use it when volume matters more than precision.

14. Signs that an IV is not flowing well include:

    1. A. Warm, dry skin at the site
    2. B. No drips with the clamp open
    3. C. A drip chamber one-third full
    4. D. Steady drips at the set rate
    Show answer

    Answer: B. No drips with the clamp open

    Check height of the bag, clamp position, and catheter placement. Swelling at the site or positional flow also suggest a problem.

15. Blood administration requires:

    1. A. A 60 gtt/mL microdrip set
    2. B. A filtered set with NS only
    3. C. A set primed with D5W or LR
    4. D. Any standard macrodrip set
    Show answer

    Answer: B. A filtered set with NS only

    Lactated Ringer's contains calcium and is traditionally avoided with blood. Use an in-line filter and normal saline as the only accompanying fluid.

16. An IV established in the field for a critical patient should be:

    1. A. Not allowed to delay transport
    2. B. Attempted three times on scene
    3. C. The top priority on scene
    4. D. Started before any airway care
    Show answer

    Answer: A. Not allowed to delay transport

    Many lines are better placed en route. Access should not delay definitive care.

17. Central venous catheters and implanted ports:

    1. A. Should never be accessed by EMS
    2. B. May be accessed per protocol
    3. C. Require no flushing after use
    4. D. Are handled like peripheral IVs
    Show answer

    Answer: B. May be accessed per protocol

    Infection risk makes technique critical. Strict aseptic technique and appropriate training are required.

18. The fluid rate for a patient in hypovolemic shock is guided by:

    1. A. A fixed volume set by protocol
    2. B. Perfusion signs and BP targets
    3. C. Patient comfort and thirst
    4. D. The maximum rate in all cases
    Show answer

    Answer: B. Perfusion signs and BP targets

    Over-resuscitation can worsen bleeding and cause dilution. Titrate to mental status and blood pressure targets.

19. Ultrasound guidance for peripheral IV placement is most useful for:

    1. A. Patients with large visible forearm veins
    2. B. Difficult access, such as obesity or IVDU
    3. C. Infants needing an umbilical line
    4. D. Cardiac arrest, before a first IV attempt
    Show answer

    Answer: B. Difficult access, such as obesity or IVDU

    Ultrasound helps find deeper veins that cannot be seen or felt, as in obesity, edema, or past IV drug use, and raises first-attempt success. Visible forearm veins do not need it, umbilical lines are placed by landmark in newborns, and in arrest ultrasound should not delay access.

20. The antecubital vein is preferred in critical patients because:

    1. A. It is the only usable vein
    2. B. It fits large-bore catheters
    3. C. It is the least painful site
    4. D. It lies nearest the heart
    Show answer

    Answer: B. It fits large-bore catheters

    AC access supports rapid fluid and drug administration. It is large and allows rapid infusion.

21. Low-titer group O whole blood given by EMS is intended for:

    1. A. Hemorrhagic shock after major trauma
    2. B. Septic shock not responding to fluids
    3. C. Hypovolemia from extensive burns
    4. D. Hypovolemia from vomiting and diarrhea
    Show answer

    Answer: A. Hemorrhagic shock after major trauma

    Prehospital whole blood programs treat life-threatening hemorrhagic shock, replacing lost oxygen-carrying capacity and clotting factors. Septic shock is treated with crystalloid and vasopressors, and burn and GI fluid losses are replaced with crystalloid, because these patients have not lost red cells and clotting factors.

22. Flow rate through a catheter is most affected by:

    1. A. The type of crystalloid used
    2. B. Catheter diameter and length
    3. C. Catheter hub color coding
    4. D. The patient's age and weight
    Show answer

    Answer: B. Catheter diameter and length

    Poiseuille's law: radius to the fourth power. Shorter, wider catheters flow faster.

23. Before IV insertion, the site should be cleansed with:

    1. A. Povidone, then wiped off at once
    2. B. Alcohol or chlorhexidine, let dry
    3. C. Saline gauze, then air-dried
    4. D. Sterile water, then patted dry
    Show answer

    Answer: B. Alcohol or chlorhexidine, let dry

    Skin antisepsis reduces infection risk.

24. A tourniquet for IV access should be:

    1. A. Snug enough to block venous return only
    2. B. Tight enough to stop arterial flow
    3. C. Loose enough to slide along the arm
    4. D. Left in place for at least 5 minutes
    Show answer

    Answer: A. Snug enough to block venous return only

    Venous engorgement helps visualize the vein; arterial flow must continue. A distal pulse should remain present.

25. After catheter insertion and flashback, the paramedic should:

    1. A. Advance a bit, then thread the catheter
    2. B. Withdraw the needle fully at once
    3. C. Pull the catheter back a few mm
    4. D. Release the tourniquet before advancing
    Show answer

    Answer: A. Advance a bit, then thread the catheter

    Advance a few millimeters further after flashback to ensure the catheter tip is in the vein. Then advance the catheter off the needle while stabilizing it.

26. After placing a saline lock, you confirm that it is patent by:

    1. A. Pulling back hard to fill the hub
    2. B. Listening for a hiss at the port
    3. C. Squeezing the hub between your fingers
    4. D. Flushing saline and watching the site
    Show answer

    Answer: D. Flushing saline and watching the site

    Flush 5 to 10 mL of saline while watching and feeling the site; easy flow without swelling or pain confirms patency. Forceful aspiration can collapse the vein, there is no hiss to hear, and squeezing the hub tells you nothing about the catheter tip.

27. After removing an IV that infiltrated with saline, the swollen arm should be:

    1. A. Wrapped tightly in an elastic bandage
    2. B. Used again for an IV above the swelling
    3. C. Elevated, with the site rechecked often
    4. D. Massaged hard to push the fluid back
    Show answer

    Answer: C. Elevated, with the site rechecked often

    Elevate the limb to help the fluid reabsorb and recheck the site for color, sensation, and swelling. Tight wrapping can impair circulation, a new IV should go in another limb or well above and away from the injury, and massage can spread an irritating fluid and damage tissue.

28. Extravasation is:

    1. A. Air entering the IV line
    2. B. Infiltration of a vesicant drug
    3. C. A normal infusion of saline
    4. D. A collapsed or sclerosed vein
    Show answer

    Answer: B. Infiltration of a vesicant drug

    Extravasation can cause necrosis. Vesicants include D50 and norepinephrine.

29. A peripheral amiodarone infusion is most likely to cause:

    1. A. Hypertension during the infusion
    2. B. Seizures during a rapid load
    3. C. Phlebitis at the infusion site
    4. D. Tachycardia from beta stimulation
    Show answer

    Answer: C. Phlebitis at the infusion site

    Amiodarone is irritating to veins, and labeling warns of peripheral phlebitis, recommending a central line for concentrations above 2 mg/mL; use a large vein and check the site. Amiodarone tends to cause hypotension and bradycardia (it has beta-blocking effects) rather than hypertension or tachycardia, and seizures are not a typical loading effect.

30. Before placing a fluid bag in a pressure infuser, you should:

    1. A. Spike it and remove the bag's air
    2. B. Inject 50 mL of air to firm it up
    3. C. Fill the drip chamber to the top
    4. D. Leave the air in to cushion the flow
    Show answer

    Answer: A. Spike it and remove the bag's air

    Air left in a bag under pressure can be driven into the vein once the fluid runs out, so remove the air from the bag before pressurizing. Adding air or leaving it in makes air embolism more likely once the fluid runs out, and a completely full drip chamber hides the drops so flow cannot be seen.

31. Signs of circulatory overload include:

    1. A. Dry skin and increased thirst
    2. B. Hypotension and flat neck veins
    3. C. Bradycardia and dry mucosa
    4. D. Dyspnea, crackles, and JVD
    Show answer

    Answer: D. Dyspnea, crackles, and JVD

    Slow or stop the infusion and reassess. Hypertension may also be present.

32. A taped IV catheter has slid partway out of the skin. You should:

    1. A. Push it back in up to the hub and retape
    2. B. Retape it and run fluid faster
    3. C. Reinsert the needle to guide it in
    4. D. Remove it rather than push it back in
    Show answer

    Answer: D. Remove it rather than push it back in

    The exposed part of the catheter is no longer sterile, and its tip may have left the vein, so remove it and place a new IV if needed. Pushing it back introduces skin bacteria, running fluid faster through a displaced catheter causes infiltration, and reinserting the needle can shear the catheter.

33. About how much of a 1-L isotonic crystalloid bolus is still in the vascular space after about an hour?

    1. A. Nearly the full 1,000 mL
    2. B. About 250 mL, a quarter
    3. C. About 750 mL, three quarters
    4. D. Less than 50 mL of it
    Show answer

    Answer: B. About 250 mL, a quarter

    Isotonic crystalloid spreads through the whole extracellular space, which is about one-quarter plasma and three-quarters interstitial fluid, so only about 250 mL stays in the vessels. That is why large volumes are needed and why crystalloid cannot replace blood. Nearly the full liter and three-quarters overstate it, and under 50 mL understates it.

34. For a patient with a traumatic brain injury, which IV fluids should be avoided?

    1. A. Normal saline
    2. B. Hypertonic 3% saline
    3. C. Packed red blood cells
    4. D. D5W and 0.45% saline
    Show answer

    Answer: D. D5W and 0.45% saline

    Hypotonic fluids such as D5W (free water once the dextrose is used) and 0.45% saline move water into brain cells and can worsen cerebral edema. Normal saline is the usual isotonic choice, hypertonic saline is used to treat raised intracranial pressure, and blood is given for hemorrhage.

35. IV fluids for a hypothermic trauma patient should be warmed to about:

    1. A. 20°C (68°F)
    2. B. 60°C (140°F)
    3. C. 4°C (39°F)
    4. D. 40°C (104°F)
    Show answer

    Answer: D. 40°C (104°F)

    Fluid warmers deliver fluid at about body temperature or slightly above (roughly 38 to 42°C), which limits further heat loss. Room-temperature (20°C) and refrigerated (4°C) fluids cool the patient, and 60°C can burn the vein and destroy red cells.

36. Why is large-volume crystalloid a poor substitute for blood in hemorrhagic shock?

    1. A. It causes hyperkalemia in large volumes
    2. B. It raises blood glucose with each liter
    3. C. It is removed at once by the kidneys
    4. D. It carries no oxygen, dilutes clotting
    Show answer

    Answer: D. It carries no oxygen, dilutes clotting

    Crystalloid carries no oxygen and dilutes red cells and clotting factors, worsening coagulopathy and acidosis, so hemorrhage is treated with blood and bleeding control. Normal saline contains no potassium and lactated Ringer's only a little, neither raises glucose, and crystalloid shifts mostly into the tissues rather than being removed at once by the kidneys.

37. A hypertonic solution (e.g., 3% saline) causes:

    1. A. Fluid to leave the vascular space
    2. B. Fluid to shift into the vessels
    3. C. Water to move into the cells
    4. D. No net shift between compartments
    Show answer

    Answer: B. Fluid to shift into the vessels

    Hypertonic saline is used in some head injury protocols. Fluid moves from cells and interstitium into the vessels.

38. The drop factor needed for a drip-rate calculation is found:

    1. A. On the IV fluid bag's label
    2. B. On the administration set package
    3. C. In the patient's home medication list
    4. D. On the catheter hub's color
    Show answer

    Answer: B. On the administration set package

    The drop factor (gtt/mL) belongs to the tubing, so it is printed on the administration set package, and it varies by manufacturer. The fluid bag label gives volume and contents, home medication lists are unrelated, and the catheter hub color shows gauge.

39. Standard blood administration (Y-type) tubing most often has a drop factor of:

    1. A. 60 gtt/mL
    2. B. 10 gtt/mL
    3. C. 100 gtt/mL
    4. D. 1 gtt/mL
    Show answer

    Answer: B. 10 gtt/mL

    Blood administration sets usually deliver about 10 gtt/mL (some 15) because blood is thicker and the in-line filter needs larger drops. 60 gtt/mL is a microdrip set, and 100 or 1 gtt/mL are not standard drop factors.

40. When flushing a saline lock, clamping while still pushing the last 0.5 mL helps to:

    1. A. Push air out of the patient's vein
    2. B. Dilute leftover drug sitting in the vein
    3. C. Prevent blood backflow into the tip
    4. D. Keep the flush syringe sterile
    Show answer

    Answer: C. Prevent blood backflow into the tip

    Clamping while still applying pressure (positive-pressure technique) keeps blood from flowing back into the catheter tip, where it could clot and block the lock. It does not push air out of the vein, dilute residual drug, or keep the syringe sterile.

41. Blood is backing up into the IV tubing. A likely cause is:

    1. A. The fluid is too cold to flow well
    2. B. The roller clamp is wide open
    3. C. The bag hangs below the IV site
    4. D. The catheter is too large
    Show answer

    Answer: C. The bag hangs below the IV site

    When the bag hangs lower than the IV site, venous pressure pushes blood back into the tubing; raise the bag above the heart. Cold fluid does not reverse flow, an open clamp lets fluid run in rather than blood back, and catheter size does not cause backflow.

42. IV sites to avoid include:

    1. A. Antecubital veins in adults
    2. B. A limb with a fistula or infection
    3. C. Straight, palpable forearm veins
    4. D. Hand veins of the dominant arm
    Show answer

    Answer: B. A limb with a fistula or infection

    These sites risk complications. Also avoid the mastectomy side and injured limbs.

43. External jugular cannulation is:

    1. A. The preferred site in young children
    2. B. Outside paramedic scope everywhere
    3. C. Used when peripheral access fails
    4. D. The routine first-line access site
    Show answer

    Answer: C. Used when peripheral access fails

    EJ is a peripheral vein but requires caution near the airway and carotid. It is used when IO is unavailable or contraindicated.

44. Blood draw for lab samples in the field is typically done:

    1. A. From the IV bag's injection port
    2. B. At IV insertion, before fluids
    3. C. After fluids have run for 5 min
    4. D. Only after hospital arrival
    Show answer

    Answer: B. At IV insertion, before fluids

    Samples should be undiluted by IV fluid.

45. In pediatric patients, the IV fluid bolus for shock is:

    1. A. 50 mL/kg
    2. B. 5 mL/kg
    3. C. 20 mL/kg
    4. D. 2 mL/kg
    Show answer

    Answer: C. 20 mL/kg

    Pediatric boluses are weight-based and reassessed after each. Use 10 mL/kg in cardiogenic shock or neonates.

46. A buretrol (volume-control chamber) is used to:

    1. A. Speed up gravity infusions
    2. B. Warm fluid before it is infused
    3. C. Limit volume, preventing overload
    4. D. Filter particles from the fluid
    Show answer

    Answer: C. Limit volume, preventing overload

    Burette chambers prevent accidental large-volume infusion. This protects children from overload.

47. Secondary (piggyback) infusions:

    1. A. Are hung lower than the primary bag
    2. B. Join the primary line, hung higher
    3. C. Require a second, separate IV site
    4. D. Replace the primary line entirely
    Show answer

    Answer: B. Join the primary line, hung higher

    Piggybacks deliver intermittent medications.

48. Fluid warming is important in:

    1. A. Trauma and hypothermic patients
    2. B. All patients in every season
    3. C. Pediatric patients only
    4. D. Summer heat emergencies
    Show answer

    Answer: A. Trauma and hypothermic patients

    Cold fluids contribute to the lethal triad in trauma. Warming prevents worsening hypothermia and coagulopathy.

49. During a prehospital transfusion, the patient develops fever, chills, and back pain. The first action is to:

    1. A. Slow the transfusion and give acetaminophen
    2. B. Stop it and keep the vein open with saline
    3. C. Continue it and give IV diphenhydramine
    4. D. Stop it and flush the line with D5W
    Show answer

    Answer: B. Stop it and keep the vein open with saline

    Fever, chills, and back pain suggest an acute hemolytic or febrile reaction: stop the transfusion at once, keep the vein open with saline through new tubing, support the patient, and save the bag. Slowing it with acetaminophen or continuing it with diphenhydramine keeps exposing the patient to the blood, and D5W hemolyzes red cells, so saline is the fluid used with blood.

50. Why is permissive hypotension avoided in a trauma patient with a severe head injury?

    1. A. Fluids are toxic to injured brain tissue
    2. B. Head injury causes fluid overload by itself
    3. C. Hypotension worsens secondary brain injury
    4. D. Low BP raises intracranial pressure directly
    Show answer

    Answer: C. Hypotension worsens secondary brain injury

    Even one episode of hypotension lowers cerebral perfusion and roughly doubles mortality after severe TBI, so the target is normal or higher blood pressure rather than permissive hypotension. Fluids are not toxic to brain tissue, head injury does not cause fluid overload by itself, and low pressure reduces perfusion rather than raising intracranial pressure.

51. The IV catheter should be secured with:

    1. A. Gauze wrapped over the site
    2. B. A circumferential elastic wrap
    3. C. Tape across the insertion site
    4. D. A clear dressing and tape
    Show answer

    Answer: D. A clear dressing and tape

    Visible sites allow detection of infiltration. Keep the site visible for inspection. Tape over the insertion site hides it, a circumferential elastic wrap can act as a tourniquet and conceal infiltration, and plain gauze also blocks the view.

52. Local complications of IV therapy include:

    1. A. Infiltration, phlebitis, hematoma
    2. B. Air embolism and pulmonary edema
    3. C. Sepsis and systemic infection
    4. D. Circulatory fluid overload
    Show answer

    Answer: A. Infiltration, phlebitis, hematoma

    Systemic complications include air embolism, sepsis, and overload. Local infection is also a local complication.

53. Catheter-related bloodstream infection risk is reduced by:

    1. A. Skipping site prep when time is short
    2. B. Using larger-bore catheters routinely
    3. C. Aseptic insertion and site prep
    4. D. Leaving field lines in for longer
    Show answer

    Answer: C. Aseptic insertion and site prep

    Field-placed IVs are often replaced within 24–48 hours. Replace field-placed lines promptly in hospital.

54. An IV that was running well stops dripping when the patient bends the elbow. The most likely cause is:

    1. A. The IV bag has run dry during the transport
    2. B. Positional kinking at the antecubital site
    3. C. A clot forming at the catheter tip
    4. D. Fluid overload causing back-pressure
    Show answer

    Answer: B. Positional kinking at the antecubital site

    Antecubital catheters are positional; straightening or splinting the arm usually restores flow. An empty bag or a clot would not stop and restart with elbow position, and back-pressure from fluid overload does not stop a gravity infusion this suddenly.

55. A new IV will not flow. The flow clamp is open and the bag is hung high. The next step is to check:

    1. A. Whether the catheter is too small
    2. B. Whether the tourniquet is still on
    3. C. Whether the drip chamber is completely full
    4. D. Whether the fluid is too cold to flow
    Show answer

    Answer: B. Whether the tourniquet is still on

    A forgotten tourniquet is a common cause of a non-flowing IV and can cause harm if left on. A small catheter or cold fluid slows flow but does not stop it, and a completely full drip chamber hides drops rather than stopping flow.

56. The drip chamber of an IV set is completely full of fluid. The problem is:

    1. A. The fluid will flow too slowly to use
    2. B. Drops cannot be seen or counted
    3. C. The tubing will separate from the bag
    4. D. The patient will receive an air embolism
    Show answer

    Answer: B. Drops cannot be seen or counted

    The chamber should be about one-third to one-half full so drips are visible; squeeze or invert to correct. The rate cannot be set without visible drops.

57. Why is calcium chloride given through a large, secure vein?

    1. A. It needs a fast flow to stay dissolved
    2. B. It must reach the heart within seconds
    3. C. It causes tissue necrosis if it leaks
    4. D. It reacts with plastic in small catheters
    Show answer

    Answer: C. It causes tissue necrosis if it leaks

    Calcium chloride is hypertonic and highly irritating; extravasation can cause severe tissue necrosis, so give it slowly through a large, patent vein (or IO). It stays dissolved at any flow, it does not need to reach the heart in seconds, and it does not react with catheter plastic.

58. A patient's IV infiltrates while dopamine is infusing. The first action is to:

    1. A. Apply a warm pack and keep running
    2. B. Stop the infusion immediately
    3. C. Massage the site to disperse it
    4. D. Flush the line to clear the drug
    Show answer

    Answer: B. Stop the infusion immediately

    Vasopressor extravasation can cause tissue necrosis; stop immediately and notify the receiving facility. Then follow protocol for vasopressor extravasation.

59. Pus at an IV site together with a new fever suggests:

    1. A. Simple mechanical phlebitis
    2. B. An allergy to the tape
    3. C. Fluid overload from the infusion
    4. D. A catheter-related infection
    Show answer

    Answer: D. A catheter-related infection

    Purulent drainage with fever points to a catheter-related infection that may involve the bloodstream; remove the catheter per protocol and report it. Mechanical phlebitis causes redness and tenderness without pus, tape allergy causes local rash, and fluid overload causes dyspnea and crackles.

60. A patient develops sudden dyspnea, chest pain, and hypotension after IV tubing disconnects from the hub. Suspect:

    1. A. Air embolism; left side, head down, oxygen
    2. B. Infiltration; elevate arm, apply cold pack
    3. C. Vasovagal response; sit the patient upright
    4. D. Phlebitis; warm compresses along the vein
    Show answer

    Answer: A. Air embolism; left side, head down, oxygen

    Left lateral Trendelenburg may help trap air in the right atrium; give high-flow oxygen and transport.

61. A winged ('butterfly') steel needle is best suited for:

    1. A. Rapid, large-volume trauma resuscitation
    2. B. Long-term vasopressor infusions
    3. C. Short-term access or drawing blood
    4. D. IO access in the proximal tibia
    Show answer

    Answer: C. Short-term access or drawing blood

    Steel winged needles are for blood draws or brief, single-dose access; their rigid tip easily punctures the vein if the patient moves. They are too small and rigid for trauma resuscitation, unsafe for vesicants such as vasopressors, and are not IO devices.

62. Which vein selection strategy is preferred when time allows?

    1. A. Use leg veins before arm veins in adults
    2. B. Start distally, then move proximally
    3. C. Start proximally, then move toward the hand
    4. D. Start at the antecubital fossa in every patient
    Show answer

    Answer: B. Start distally, then move proximally

    Starting distal preserves proximal sites for later attempts.

63. Which site is the poorest choice for IV access in a trauma patient?

    1. A. The uninjured, opposite arm
    2. B. An unburned forearm vein
    3. C. An AC vein above a small hand cut
    4. D. A fractured arm, below the break
    Show answer

    Answer: D. A fractured arm, below the break

    Fluid given below a fracture may leak at the injury and add to swelling and compartment pressure, and the limb may need surgery, so use an uninjured limb. The uninjured arm, an unburned forearm, and a vein above a minor hand cut are all reasonable choices.

64. A patient with a history of right mastectomy with lymph node removal needs an IV. The best choice is:

    1. A. The right arm, because it has larger veins
    2. B. The left arm, if suitable
    3. C. Either arm; it makes no difference
    4. D. The right antecubital fossa only
    Show answer

    Answer: B. The left arm, if suitable

    Lymphedema risk generally leads providers to avoid the affected arm when alternatives exist.

65. Which finding best confirms a peripheral catheter is in the vein after insertion?

    1. A. The patient reports pain at the site
    2. B. Blood leaking around the catheter hub
    3. C. The drip chamber shows no drops falling
    4. D. Free flow with no swelling at the site
    Show answer

    Answer: D. Free flow with no swelling at the site

    Easy flow without swelling, and sometimes blood return, indicates intravascular placement.

66. An older adult has fragile veins that blow easily. Which adjustment helps?

    1. A. Choose the largest-bore catheter available
    2. B. Insert at a steep 60-degree angle
    3. C. Loose or no tourniquet, smaller catheter
    4. D. Tighten the tourniquet to raise the vein
    Show answer

    Answer: C. Loose or no tourniquet, smaller catheter

    Excessive venous pressure and large catheters increase the risk of blown fragile veins.

67. Through the same catheter, packed red cells flow more slowly than saline mainly because of their:

    1. A. Lower osmolality
    2. B. Higher potassium
    3. C. Higher viscosity
    4. D. Higher oncotic pressure
    Show answer

    Answer: C. Higher viscosity

    Poiseuille's law shows flow falls as viscosity rises, and packed red cells are much thicker than saline, so they run slowly unless pressurized or diluted. Osmolality, potassium content, and oncotic pressure do not slow flow through a catheter; thickness does.

68. Raising the height of the IV bag increases flow because:

    1. A. It warms the fluid in the tubing
    2. B. It widens the lumen of the catheter
    3. C. It raises the driving hydrostatic pressure
    4. D. It lowers the viscosity of the fluid
    Show answer

    Answer: C. It raises the driving hydrostatic pressure

    Gravity-fed flow rises with height of the fluid above the site; pressure bags further increase flow.

69. A patient with heart failure receiving a fluid bolus develops crackles and worsening dyspnea. The paramedic should:

    1. A. Switch to a hypotonic solution
    2. B. Lay the patient flat to improve breathing
    3. C. Slow or stop the fluid and reassess
    4. D. Increase the rate to improve perfusion
    Show answer

    Answer: C. Slow or stop the fluid and reassess

    These are signs of fluid overload; reduce the rate and treat respiratory distress.

70. Which solution is hypertonic?

    1. A. D50W
    2. B. 0.9% sodium chloride
    3. C. Lactated Ringer's
    4. D. 0.45% sodium chloride
    Show answer

    Answer: A. D50W

    D50W has very high osmolarity and is irritating to veins, so infiltration can cause tissue injury.

71. Which IV solution is most appropriate as an initial fluid for a hypovolemic trauma patient if blood is unavailable?

    1. A. D10W, to support blood glucose
    2. B. D5W, to provide glucose and free water
    3. C. 0.45% sodium chloride at a rapid rate
    4. D. Normal saline or lactated Ringer's
    Show answer

    Answer: D. Normal saline or lactated Ringer's

    Isotonic crystalloids expand the intravascular space; hypotonic and dextrose solutions shift into cells. Both are isotonic crystalloids.

72. Using the 4-2-1 rule, the hourly maintenance fluid rate for a 20-kg child is:

    1. A. 80 mL/hr
    2. B. 60 mL/hr
    3. C. 40 mL/hr
    4. D. 20 mL/hr
    Show answer

    Answer: B. 60 mL/hr

    4 mL/kg/hr for the first 10 kg (40) + 2 mL/kg/hr for the next 10 kg (20) = 60 mL/hr. 80 mL/hr applies 4 mL/kg to all 20 kg, 40 mL/hr counts only the first 10 kg, and 20 mL/hr counts only the second 10 kg.

73. A large volume of normal saline can cause which metabolic abnormality?

    1. A. Severe hyperkalemia
    2. B. Metabolic alkalosis
    3. C. Hyperchloremic acidosis
    4. D. Hypernatremic dehydration
    Show answer

    Answer: C. Hyperchloremic acidosis

    Normal saline's high chloride content can cause a non-anion gap acidosis.

74. Before starting a prehospital unit of blood, what must be verified?

    1. A. Product, unit number, expiry, and patient
    2. B. Product type and bag volume alone
    3. C. The donor's name and address
    4. D. That the unit has warmed to room temperature
    Show answer

    Answer: A. Product, unit number, expiry, and patient

    Two-person verification of the product type, unit number, expiration, and the patient's identity (and blood type, if known) prevents a wrong-blood transfusion. The product type and volume alone do not confirm the right unit for the right patient, donor identity is confidential and irrelevant, and blood is warmed with a device rather than left to sit at room temperature.

75. A pressure infuser on an IV bag is used to:

    1. A. Warm the fluid before it reaches the patient
    2. B. Hold the infusion at a precise, slow rate
    3. C. Speed flow when rapid volume is needed
    4. D. Filter particulate matter out of the fluid
    Show answer

    Answer: C. Speed flow when rapid volume is needed

    External pressure overcomes resistance for faster delivery; monitor closely for air.

76. While setting up a fluid bolus, you notice the bag label reads 'NS with 20 mEq KCl.' You should:

    1. A. Run it wide open as an ordinary bolus
    2. B. Not bolus it; get a bag of plain saline
    3. C. Run it at half the usual bolus speed
    4. D. Add another 500 mL of saline to the bag
    Show answer

    Answer: B. Not bolus it; get a bag of plain saline

    A potassium-containing bag must never be given as a bolus; rapid potassium can cause fatal dysrhythmias, so use plain saline. Running it wide open or at half speed still delivers potassium far too fast, and adding saline to the bag creates an unlabeled concentration.

77. While spiking a bag, you touch the spike with your glove. You should:

    1. A. Wipe the spike with alcohol and spike
    2. B. Spike anyway; gloves are clean
    3. C. Replace it with a new tubing set
    4. D. Rinse the spike with sterile saline
    Show answer

    Answer: C. Replace it with a new tubing set

    The spike must stay sterile because it enters the fluid; once touched, replace the administration set. Wiping or rinsing does not restore sterility, and exam gloves are clean but not sterile.

78. Which finding in the external jugular vein makes it more favorable for cannulation?

    1. A. It is flat with the head raised 45 degrees
    2. B. It is distended with the head turned away
    3. C. It pulses strongly beneath the finger
    4. D. It lies deep, just behind the trachea
    Show answer

    Answer: B. It is distended with the head turned away

    Lowering the head and turning it away distends the EJ; occluding it above the clavicle helps.

79. When cannulating the external jugular vein, the paramedic should:

    1. A. Occlude it just above the clavicle
    2. B. Aim the needle toward the ear
    3. C. Apply a tourniquet around the neck
    4. D. Sit the patient fully upright
    Show answer

    Answer: A. Occlude it just above the clavicle

    Gentle pressure above the clavicle acts as a tourniquet; the needle is aimed toward the same-side shoulder. Occluding the vein above the clavicle distends it.

80. In an infant, which peripheral IV site is an acceptable option that adults lack?

    1. A. The subclavian vein below the clavicle
    2. B. The external jugular vein
    3. C. Superficial scalp veins
    4. D. The dorsal veins of the hand
    Show answer

    Answer: C. Superficial scalp veins

    Infants have prominent superficial scalp veins that can be used for peripheral IVs when hand, foot, and arm veins fail. The subclavian is a central line site, and adults also have external jugular and dorsal hand veins, so neither is unique to infants.

81. A patient's PICC line is cracked and leaking. The immediate action is to:

    1. A. Pull the whole catheter out on scene
    2. B. Tape over the crack and resume the infusion
    3. C. Flush hard to clear it through the crack
    4. D. Clamp it between the crack and the patient
    Show answer

    Answer: D. Clamp it between the crack and the patient

    Clamp the catheter between the damage and the patient to prevent air embolism and bleeding, cover the break with sterile gauze, and transport. Field removal of a PICC is not indicated, taping and resuming infusion risks infection and air entry, and flushing forces fluid out through the crack.

82. Why do hospitals often replace field-placed IVs within about 48 hours?

    1. A. Field catheters dissolve after a day
    2. B. Field fluids expire once hung
    3. C. Field aseptic technique is less certain
    4. D. Hospitals use a different catheter size
    Show answer

    Answer: C. Field aseptic technique is less certain

    CDC recommends replacing catheters placed under emergency conditions, where asepsis cannot be ensured, as soon as possible and within 48 hours to reduce infection. Catheters do not dissolve, hung fluids are not the reason, and catheter size is not the issue.

83. A dehydrated child's veins are difficult to see. Which technique may help locate a vein?

    1. A. Applying a cold pack to the site
    2. B. Raising the limb above heart level
    3. C. Warming the limb or transillumination
    4. D. Choosing a larger catheter than usual
    Show answer

    Answer: C. Warming the limb or transillumination

    Warming dilates veins; transillumination or ultrasound can help visualize them.