10 free AEMT practice questions: IV Therapy and Fluid Administration

Reinsert the needle slowly and advance only if blood returns: Going slowly does not change the problem. The bevel still sits against the inside wall of a catheter that has moved. A slow push shears the tip just as cleanly as a fast one.

Reinsert the needle and advance the catheter under low pressure: Low pressure has the same problem as going slowly. The shear happens because the needle edge meets plastic that is no longer seated on the needle. How hard you push does not matter.

Leave the catheter in place and attach tubing to test the flow: Testing the flow would make sense for a catheter that is fully in place. This catheter is halfway out and no longer reliably in the vein. Fluid run through this catheter goes into the tissue and delays the access this patient needs.

Leave the catheter in place and run fluid to keep the vein open: Running fluid to keep the vein open is right when the catheter sits in an intact vein. This vein has been punctured, and blood is already leaking into the tissue. Fluid run through this catheter goes into the tissue too and makes the hematoma bigger.

Apply a warm pack and attempt the same vein slightly higher up: A warm pack does not stop bleeding. Firm direct pressure is what stops bleeding from a punctured vein. This patient is on Eliquis and the swelling is still rising, so the site needs pressure now. Moving on to another attempt first leaves the hematoma growing.

Wrap the arm loosely and reattempt below the swelling in the hand: A loose wrap puts no real pressure on the site, so the bleeding keeps going. The hand is below the swelling and drains through the same punctured vein. Fluid run in the hand travels up that vein toward the heart and leaks out at the puncture into the hematoma.

Written orders from the sending physician for the pump settings: Written orders tell a provider what to do inside that provider's scope. A written order does not change what your certification allows, so the order cannot make a drug drip yours to run.

A second AEMT to watch the pump while the first drives the unit: A second AEMT adds another set of hands at the same level. Neither AEMT can adjust a drug infusion, so two AEMTs still cannot run the pump.

A telephone line to online medical direction for the rate changes: Online medical direction can guide decisions that are already inside your scope. A physician on the phone still cannot make a medicated infusion something you are certified to manage.

Halve the dose, because marrow absorbs faster than a vein does: Halving the dose because the route is different underdoses a patient who is barely breathing. The marrow empties into the same circulation the vein does. Nothing about the IO route calls for a smaller dose.

Double the dose, because marrow absorbs more slowly than a vein: Doubling the dose is wrong in the other direction. Once the drug is in the veins, there is no slower absorption to make up for.

Give the same dose, but only after the line has run for a minute: An IO line does need a flush to open the marrow before fluid will flow. After the flush, there is no waiting period before you can give a medication.

The right proximal tibia, through the burned skin: The proximal tibia is the most common IO site, in adults and children both. This right lower leg is burned, and a burn over the site rules the site out.

The left proximal tibia, where the burn is least severe: The left leg is burned all the way around too, so there is no unburned skin over the left tibia. A lighter burn is still a burn over the site. A burn over the site sends you to a different limb, not to a careful attempt through the least burned spot.

The distal femur just above the burned knee: The distal femur is an extra IO option, used mostly in young children. This patient is 35. The unburned upper arm gives you the proximal humerus, an adult site with a higher flow rate, well away from the burns.

Let both liters run and check a pressure after the second bag: A blood pressure check does count as a reassessment. With the clamp wide open, both liters run in before that check happens. One pressure after two liters tells you less than a full exam between each bolus.

Leave the line wide open, because the pressure is the priority: A normal blood pressure is not the goal in a patient who is still bleeding. Pushing the pressure up dilutes the clotting factors and can break up the clot at the bleeding site. Perfusion is the goal, and you check it between measured boluses. A wide open line with nobody watching gives you no reassessment at all.

Slow the line to a keep-vein-open rate until the hospital calls: A keep-vein-open rate fits a stable patient who does not need volume. This patient is hypotensive from an active GI bleed and needs real fluid boluses. Slowing to a keep-vein-open rate holds back the treatment the low pressure calls for.

Antecubital fossa (median cubital vein at the elbow crease): The median cubital vein at the elbow crease is big and easy to hit. The vein sits in the antecubital fossa, which is a joint. When the patient bends the elbow, the catheter can kink or tear the vein. Save the antecubital site for when you need fast, large-volume access. This patient only needs a line for routine medications.

A vein in the arm on the same side as a prior mastectomy with lymph node removal: Nothing else is wrong with this arm, and the vein may be easy to reach. Removing the lymph nodes during the mastectomy changed how lymph drains from that arm. Putting an IV in that arm raises the risk of lymphedema and infection. The whole arm is off limits, not just a second choice.

A vein located distal to a suspected forearm fracture site: A vein below a suspected forearm fracture may look usable. Starting an IV below the fracture risks fluid leaking into injured tissue. The leaking fluid adds to swelling that is already threatening circulation in that arm. Go above the fracture or use the other arm.

D5W, because the dextrose supplies energy while the fluid expands the circulating volume: D5W looks like a volume expander because the bag is isotonic when it goes in. Once the body uses up the dextrose, only free water is left. Free water spreads through all the water in the body instead of staying in the blood vessels. D5W gives this trauma patient no lasting volume in the vessels. You see D5W used as a maintenance fluid or to carry medications, not as a resuscitation fluid.

D50, because a concentrated dextrose bolus acts more rapidly than a liter of crystalloid can infuse: D50 is a concentrated dextrose bolus for confirmed hypoglycemia. Nothing in this question points to a low blood glucose. Pushing dextrose fast does not replace the circulating volume this patient has lost.

Half-normal saline, because it rehydrates the body's cells as well as the vascular space: Half-normal saline is hypotonic. Much of the water in half-normal saline moves out of the blood vessels and into the cells. Water moving into the cells works against what you need here, which is putting volume back in the vessels of a hypovolemic trauma patient.

Infuse both lines wide open until the systolic pressure reaches 120: A normal blood pressure sounds like the goal of giving fluid. Bleeding inside the abdomen cannot be compressed in the field. For that kind of bleeding, the fluid target is a pressure band well below normal, not a systolic of 120.

Slow both lines to a keep-vein-open rate now that the patient is talking: A patient who is talking and answering appropriately looks like a patient who is doing better. You slow the line to a keep-vein-open rate once the vital signs come back to normal and stay normal. A BP of 86/58 with a pulse of 116 is not a normal set of vital signs.

Titrate the infusion to keep the systolic pressure between 100 and 110: A patient with chronic high blood pressure can be in shock with a systolic above 100. That cutoff of 100 helps you recognize shock in a hypertensive patient. The cutoff is not the fluid target for uncontrolled internal bleeding. For that bleeding the band runs lower, at 70 to 90.

Establish both lines on scene before beginning transport: Starting a line is easier in a parked ambulance, and starting fluid sooner can sound like better care. This patient is already loaded and the crew is ready to move. Time spent on scene for IV access is time added before this patient reaches the trauma center.

Establish one line on scene and the second en route: One line now and one later still holds the ambulance on scene. The scene delay is the problem, no matter how many lines you start before leaving.

Begin transport and establish one small-bore line en route: A small catheter is easier to thread into the collapsed veins of a patient in shock. Catheter size changes how fast fluid can flow. A small-bore line gives volume too slowly for a patient this poorly perfused. Shock care calls for two large-bore lines started en route.