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Leave the catheter in place and attach tubing to test the flow: A catheter that is half withdrawn is no longer reliably in the vessel, so running fluid through it puts that fluid into the tissue and delays the access the patient needs.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 to keep a vein open is standard when the catheter is patent and the vessel is intact, but here the vessel wall has already been breached. Pushing fluid through it drives more volume into the tissue and grows the hematoma you're trying to stop.

Apply a warm pack and attempt the same vein slightly higher up: A warm pack has a role later, once bleeding has stopped, because heat increases local blood flow, the opposite of what a leaking vessel needs right now; going back into the same vein just above a fresh hematoma also just sends fluid out the lower puncture.

Wrap the arm loosely and reattempt below the swelling in the hand: A loose wrap generates no real compression, and a site distal to the hematoma still drains through the same injured vein, so infused fluid leaks out at the puncture instead of running to the heart.

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: The tibia is the site AEMTs default to first, but going through the burned skin on the right lower leg drives contaminated eschar and debris straight into the marrow, the exact scenario the contraindication exists to prevent.

The left proximal tibia, below the burned area: You might reach below the burn line on the left tibia since that site is standard teaching's first choice, but circumferential means the burn wraps all the way around both lower legs, leaving no unburned window anywhere on that limb; the whole leg is compromised, not just the burned patch, so it stays ruled out.

The distal femur just above the burned knee: The distal femur is the primary IO site in infants and young toddlers, not a 35-year-old, and this one also sits directly above a burned knee, giving two separate reasons to skip it.

Let both liters run and check a pressure after the second bag: A pressure check does count as reassessment, but the clamp is already wide open, so both liters run before that check happens, and one blood pressure after two liters is thinner evidence than the ongoing exam boluses give you between doses.

Leave the line wide open, because the pressure is the priority: Running the line wide open toward a pressure number treats blood pressure as the steering wheel, but pressure is a late sign in shock and by the time it drops the damage of over-infusion is already done; this patient needs measured, reassessed volume, not unmonitored flow.

Slow the line to a keep-vein-open rate until the hospital calls: A keep-vein-open rate fits a patient who is stable and doesn't need volume, but this patient is hypotensive from an active GI bleed and needs a real fluid bolus, not a trickle; slowing to KVO withholds the treatment the hypotension calls for.

Antecubital fossa (median cubital vein at the elbow crease): The median cubital vein at the elbow crease is large and easy to hit, which makes it tempting. It crosses the antecubital fossa, a joint, so elbow flexion can kink the catheter or shear the vessel during a routine infusion. Save this site for situations needing rapid, large-volume access, not routine medication administration when a forearm or hand vein works.

A vein in the arm on the same side as a prior mastectomy with lymph node removal: This arm is accessible and no other injury is present, but axillary lymph node removal from the mastectomy disrupts lymphatic drainage in that limb, raising the risk of lymphedema and infection if it's cannulated. That risk, not routine access needs, rules the entire limb out, not just as a second choice.

A vein located distal to a suspected forearm fracture site: A distal vein below a suspected forearm fracture assumes any patent vein will do. Cannulating distal to a fracture risks infiltration into compromised tissue and worsens swelling that already threatens circulation, so IV access should go proximal to or on the unaffected limb instead. This is a site to avoid, not a step out of order.

D5W, because the dextrose supplies energy while the fluid expands the circulating volume: D5W looks like a reasonable volume expander because the bag itself is isotonic going in, but once the dextrose is metabolized the remaining free water disperses through total body water instead of staying in the vessels, so it produces no sustained intravascular expansion for this trauma patient in shock; it's used as a maintenance or medication-carrier fluid, not 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 reserved for documented hypoglycemia, and nothing in this presentation points to a low blood glucose; pushing it faster than a liter of crystalloid can infuse doesn't replace lost circulating volume.

Half-normal saline, because it rehydrates the body's cells as well as the vascular space: Half-normal saline is hypotonic, so much of the infused water moves out of the vascular space into the cells, which works against the goal of restoring the volume deficit in a hypovolemic trauma patient.

Infuse both lines wide open until the systolic pressure reaches 120: 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 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 chronically hypertensive patient can be in shock above 100, and this carries 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 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: 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 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.