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 geometry. The bevel still sits against the inside wall of a catheter that has moved, and slow pressure shears it just as cleanly as fast pressure.

Reinsert the needle and advance the catheter under low pressure: Low pressure has the same problem. The shear happens because the needle edge meets plastic that is no longer seated on it, not because the push was forceful.

Leave the catheter in place and attach tubing to test the flow: A catheter that is half withdrawn is no longer reliably in the vessel, so running fluid through it puts that fluid into the tissue and delays the access the patient needs.

Leave the catheter in place and run fluid to keep the vein open: Running fluid through a vessel that is already leaking pushes more volume into the tissue and enlarges the swelling you are trying to stop.

Apply a warm pack and attempt the same vein slightly higher up: Heat increases blood flow to the area, which is the opposite of what a leaking vessel needs, and sticking the same vein above a fresh hematoma sends fluid straight back out of the lower hole.

Wrap the arm loosely and reattempt below the swelling in the hand: A loose wrap applies no real pressure, and a site below the injury drains into the vein you just punctured, so the fluid leaks out at the hematoma.

Written orders from the sending physician for the pump settings: Paperwork does not change what your certification allows. An order written on a page authorizes a provider who is already permitted to perform the act.

A second AEMT to watch the pump while the first drives the unit: Two AEMTs are still two AEMTs. Adding a second set of hands at the same certification level does not add the ability to titrate a drug infusion.

A telephone line to online medical direction for the rate changes: A physician on the phone can direct choices inside your scope, and cannot reach through the phone and make a medicated infusion something you are certified to manage.

Halve the dose, because marrow absorbs faster than a vein does: Cutting a dose because the route feels different underdoses a patient who is barely breathing. The marrow empties into the same circulation the vein does.

Double the dose, because marrow absorbs more slowly than a vein: Doubling is just as wrong in the other direction. There is no absorption penalty to compensate for once the drug is in the venous circulation.

Give the same dose, but only after the line has run for a minute: A flush is required to open the marrow before fluid will move, and there is no waiting period that has to pass before a medication may be given.

The right proximal tibia, through the burned skin: Going through burned skin drives contaminated tissue into the marrow, which is exactly what the contraindication exists to prevent.

The left proximal tibia, below the burned area: Circumferential means the burn wraps the whole leg, so there is no clean window below it, and the distal tibia is still the same compromised limb.

The distal femur just above the burned knee: The femur sits above a burned knee in burned tissue, and it is a site used mainly in young children rather than in an adult.

Let both liters run and check a pressure after the second bag: Checking a pressure after two liters means the first sign of overload reaches you two liters late, and one number is thinner evidence than a full reassessment.

Leave the line wide open, because the pressure is the priority: Pressure is a late sign and a poor steering wheel. Running unmonitored toward it is how the fluid that was helping starts backing into the lungs.

Slow the line to a keep-vein-open rate until the hospital calls: A keep-vein-open rate withholds the treatment a hypotensive bleeding patient needs, and nothing about the presentation calls for holding fluid.

Antecubital fossa (median cubital vein at the elbow crease): The antecubital fossa is an acceptable secondary site, reserved for when rapid large-volume access is anticipated, because it crosses a joint and is prone to kinking with movement. It is not the first choice for routine medication administration.

A vein in the arm on the same side as a prior mastectomy with lymph node removal: The arm on the same side as a mastectomy with lymph node removal should be avoided for intravenous access; impaired lymphatic drainage increases the risk of swelling and infection in that limb.

A vein located distal to a suspected forearm fracture site: Sites distal to a suspected fracture should be avoided when possible.

D5W, because the dextrose supplies energy while the fluid expands the circulating volume: D5W does not produce sustained volume expansion: once the dextrose is metabolized, the remaining free water leaves the vascular space, so it cannot resuscitate hypovolemic shock; it is typically reserved as a keep-vein-open carrier fluid.

D50, because a concentrated dextrose bolus acts more rapidly than a liter of crystalloid can infuse: D50 is a concentrated dextrose bolus for treating documented hypoglycemia; however quickly it can be pushed, it does not replace lost intravascular volume, and nothing in this presentation suggests a low blood glucose.

Half-normal saline, because it rehydrates the body's cells as well as the vascular space: Half-normal saline is hypotonic: much of the infused water shifts out of the vascular space toward the cells, which is the opposite of what a volume-depleted trauma patient needs; isotonic crystalloid is the resuscitation standard.

Infuse both lines wide open until the systolic pressure reaches 120: A student picks this because a normal blood pressure looks like the goal of fluid resuscitation. Bleeding into the abdomen cannot be compressed in the field, and the fluid guidance for internal and non-compressible bleeding names a pressure band well below normal rather than restoration of a normal pressure.

Slow both lines to a keep-vein-open rate now that the patient is talking: A student picks this because a patient talking appropriately reads as a good response. The infusion is slowed to a keep-vein-open rate when the vital signs return to normal and stay normal; a blood pressure 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 student picks this because they remember that a chronically hypertensive patient can be in shock above 100 and carry that number across. That rule adjusts how shock is recognized in a hypertensive patient; it is not the titration target for uncontrolled internal hemorrhage, where the stated band runs lower.

Establish both lines on scene before beginning transport: A student picks this because a stationary ambulance is an easier place to cannulate and starting fluid sooner sounds like better care. Shock management calls for rapid transport without unnecessary scene delays; the patient is already loaded and the crew is ready, so time spent parked buys line access at the cost of time to definitive hemorrhage control.

Establish one line on scene and the second en route: A student picks this because splitting the difference feels safe: one line secured now, one later. It is still a scene delay for a patient who is already loaded, and it is the delay itself, not the number of attempts, that the guidance targets.

Begin transport and establish one small-bore line en route: A student picks this because a smaller catheter threads more easily into the collapsed veins of a poorly perfused patient. Catheter diameter is one of the factors the guidance names as affecting flow, and shock management specifies two large-bore lines started en route; a small-bore line in a patient this poorly perfused delivers volume too slowly to change the outcome.