Intravenous Fluids Practice Questions
20 free Intravenous Fluids practice questions for the NCLEX Exam. Tap an option to answer — you get instant feedback, the correct answer, and a detailed explanation for every question.
Which fluid is most appropriate for a patient with hypotension due to intravascular volume depletion?
- A 0.45% NaCl (½ NS)
- B 0.9% NaCl (normal saline)
- C 3% NaCl
- D D5W alone
Correct answer: 0.9% NaCl (normal saline)
Normal saline (0.9% NaCl) is isotonic and ideal for intravascular volume restoration in fluid loss, making it the best initial choice for a patient with hypotension.
Which is the main risk associated with administering hypertonic saline to a patient with hyponatremia and cerebral edema?
- A Worsening cerebral edema from the infusion
- B Cellular dehydration with osmotic demyelination
- C Profound hypotension during the infusion
- D Intracellular volume overload and cell swelling
Correct answer: Cellular dehydration with osmotic demyelination
Hypertonic saline can lead to osmotic demyelination syndrome due to rapid water movement out of cells into the intravascular space.
Why is hypotonic IV fluid like 0.45% NaCl considered risky in patients with intravascular depletion?
- A It increases intravascular volume by staying in vessels
- B It draws water out of cells into the bloodstream rapidly
- C It shifts water into cells, worsening intravascular depletion
- D It remains entirely within the vascular compartment long-term
Correct answer: It shifts water into cells, worsening intravascular depletion
Hypotonic solutions like 0.45% NaCl have lower solute concentration than plasma, causing fluid to shift into cells and potentially worsening intravascular depletion.
What is a common complication of rapid IV fluid infusion that can result in pulmonary edema?
- A Metabolic alkalosis from electrolyte shifts
- B Intravascular volume overload causing pulmonary edema
- C Intracellular dehydration with cellular shrinkage
- D Permanent suppression of the immune response
Correct answer: Intravascular volume overload causing pulmonary edema
Rapid intravenous fluid infusion, especially isotonic fluids, can lead to intravascular volume overload, increased hydrostatic pressure, and subsequent pulmonary edema.
In which condition would lactated Ringer’s (LR) be less desirable as an IV fluid choice for a post-operative patient?
- A Moderate GI fluid loss
- B Slight metabolic acidosis
- C Hyperkalemia
- D Mild hyponatremia
Correct answer: Hyperkalemia
LR contains potassium which can exacerbate hyperkalemia in patients, posing a risk of dysrhythmias.
What type of IV fluid is best suited for maintenance therapy in a patient without significant intravascular volume deficit?
- A A 0.9% NaCl fluid bolus given rapidly
- B Hypertonic saline solution (3% NaCl)
- C A dextrose-containing solution such as D5½NS
- D A colloid solution such as 5% albumin
Correct answer: A dextrose-containing solution such as D5½NS
For maintenance therapy without a significant volume deficit, mixed solutions like D5½NS are suitable as they contain some dextrose and isotonic/hypotonic bases.
Which of the following IV fluids is classified as isotonic?
- A 0.45% NaCl
- B 3% NaCl
- C 0.9% NaCl
- D D5W (alone, after dextrose metabolism)
Correct answer: 0.9% NaCl
0.9% NaCl is considered isotonic as its solute concentration closely resembles that of plasma, thereby avoiding major osmotic shifts.
As a patient with severe burn injuries receives large-volume IV fluids, what complication should be monitored as the burn shock phase resolves?
- A Persistent hypovolemia with low urine output
- B Ongoing third-spacing into the interstitium
- C Fluid overload and tissue edema as capillary leak resolves
- D Hypertonic dehydration with rising serum sodium
Correct answer: Fluid overload and tissue edema as capillary leak resolves
During burn shock resolution, fluids that were third-spaced may re-enter the intravascular space, leading to fluid overload and tissue edema as capillary leakage resolves.
Which IV fluid is most likely contraindicated in a patient with traumatic brain injury and increased intracranial pressure?
- A 3% NaCl (hypertonic saline)
- B 0.9% NaCl (normal saline)
- C 0.45% NaCl (half normal saline)
- D Lactated Ringer's solution
Correct answer: 0.45% NaCl (half normal saline)
Hypotonic fluids such as 0.45% NaCl shift water into brain cells, aggravating cerebral edema and raising intracranial pressure, so they are contraindicated in TBI with elevated ICP. Hypertonic (3%) saline is instead used to reduce ICP.
What is the appropriate nursing intervention for a patient with IV fluid infiltration at a peripheral site?
- A Increase infusion rate
- B Continue infusion but monitor
- C Stop infusion and remove IV catheter
- D Switch to hypertonic solution
Correct answer: Stop infusion and remove IV catheter
In case of infiltration, stopping the infusion, removing the catheter, and restarting at a new site is crucial to prevent tissue damage.
Upon a patient developing bradycardia, hypotension, and shortness of breath during IV therapy, what complication should be suspected?
- A Phlebitis along the venous access site
- B Air embolism entering the circulation
- C Fluid volume overload with congestion
- D Hypovolemia from inadequate replacement
Correct answer: Fluid volume overload with congestion
The symptoms suggest fluid overload, which may lead to pulmonary involvement and decreased cardiac output, necessitating prompt recognition and intervention.
For a patient receiving hypertonic saline, what monitoring parameter is most crucial due to the risk of osmotic demyelination?
- A Urine specific gravity measured each shift
- B Serum sodium with neurologic status
- C Blood glucose checked before each infusion
- D Platelet count monitored daily
Correct answer: Serum sodium with neurologic status
Frequent checks of serum sodium levels and neurologic status are vital during hypertonic saline infusion to prevent rapid sodium rises and associated neurologic complications.
What fluid type is most suitable for treating intracellular dehydration rather than solely intravascular depletion?
- A 0.9% NaCl
- B 3% NaCl
- C 0.45% NaCl
- D Colloid albumin
Correct answer: 0.45% NaCl
Intracellular dehydration calls for hypotonic fluid to shift water into cells, making 0.45% NaCl a better choice to draw fluid from the intravascular to the intracellular space.
Why might colloid solutions such as albumin be preferred over crystalloids in certain situations?
- A They expand intravascular volume more per liter than crystalloids
- B They reliably shift fluid into the interstitial space
- C They are always the first-line choice for hypovolemia
- D They universally cause fewer infusion complications
Correct answer: They expand intravascular volume more per liter than crystalloids
Colloids contain large molecules that stay in the vascular space, providing a higher intravascular volume expansion compared to crystalloids, although they may not always be the first-line choice.
When infusing D5W, what is a key concern with this fluid alone due to metabolic processes?
- A Localized redness limited to the insertion site
- B Swelling confined to the catheter insertion site
- C Pulmonary edema, electrolyte imbalance, or infection
- D Hair loss occurring around the insertion site
Correct answer: Pulmonary edema, electrolyte imbalance, or infection
D5W shifts to a hypotonic state after dextrose metabolism, potentially posing a risk of cellular overhydration due to intracellular fluid uptake.
What is a systemic complication associated with IV therapy that necessitates monitoring, indicating the involvement of the whole body?
- A Isotonic 0.9% NaCl infused for routine maintenance
- B D5½NS run at a maintenance rate
- C D5W given at a minimal infusion rate
- D A colloid solution such as albumin
Correct answer: Isotonic 0.9% NaCl infused for routine maintenance
Systemic complications of IV therapy involve conditions like fluid overload, electrolyte imbalances, and catheter-related infections, impacting the entire body.
Which IV fluid is least suitable for routine maintenance in a patient with heart failure at risk of volume overload?
- A 0.9% NaCl
- B D5½NS
- C D5W with minimal rate
- D Colloid solution
Correct answer: 0.9% NaCl
In patients with heart failure and volume overload risk, isotonic saline like 0.9% NaCl may add burden to intravascular volume, making cautious fluid choices necessary.
For correcting mild metabolic acidosis following GI losses, which fluid is the most appropriate?
- A 0.9% NaCl
- B 0.45% NaCl
- C Lactated Ringer’s
- D D5W alone
Correct answer: Lactated Ringer’s
Lactated Ringer’s, an alkalinizing crystalloid, aids in correcting acidosis from GI losses by providing metabolizable lactate that converts to bicarbonate.
Upon a patient developing phlebitis at a peripheral IV site, what should be the nurse's priority action?
- A Crystalloids never leave the intravascular space at all
- B Large crystalloid volumes may cause interstitial edema and overload
- C Daily weight changes are irrelevant during IV fluid therapy
- D Lung sounds do not reflect a patient's fluid status
Correct answer: Large crystalloid volumes may cause interstitial edema and overload
Phlebitis necessitates catheter removal to prevent further damage or infection, making it crucial to document and restart at another site.
Why should lung sounds and daily weight be monitored in a patient receiving large-volume crystalloids during IV therapy?
- A Crystalloids never leave the intravascular space
- B Large volumes of crystalloids may lead to interstitial edema and fluid overload
- C Daily weight changes are irrelevant in IV therapy
- D Lung sounds do not reflect fluid status
Correct answer: Large volumes of crystalloids may lead to interstitial edema and fluid overload
Monitoring lung sounds and weight is essential as large crystalloid volumes can cause tissue edema and pulmonary congestion, necessitating early detection of fluid overload.