LVN IV Therapy & Fluid Management 5 — Questions and Answers
Question 1: A patient receiving 0.45% NaCl IV is at risk for which type of fluid shift?
- Fluid moving from cells into the vascular space
- Fluid moving from the vascular space into cells (Correct answer)
- Fluid moving from the interstitial space into cells
- No fluid shift occurs with this solution
Correct answer: Fluid moving from the vascular space into cells
0.45% NaCl is hypotonic; once infused, it shifts water from the vascular space into cells, which can cause cellular swelling.
Question 2: The LVN is caring for a patient with hypermagnesemia. Which finding requires immediate notification of the physician?
- Mild constipation
- Loss of deep tendon reflexes (Correct answer)
- Slight elevation in blood pressure
- Mild facial flushing
Correct answer: Loss of deep tendon reflexes
Loss of deep tendon reflexes is an early warning sign of severe hypermagnesemia and impending respiratory depression or cardiac arrest.
Question 3: Which practice best reduces the risk of catheter-associated bloodstream infection (CLABSI) when maintaining a central line?
- Change central line dressings only when visibly soiled
- Use strict aseptic technique and chlorhexidine for site care (Correct answer)
- Cap the line with gauze when not in use
- Flush with tap water between medication doses
Correct answer: Use strict aseptic technique and chlorhexidine for site care
CLABSI prevention requires strict aseptic technique with chlorhexidine-based antiseptics, sterile dressings, and proper hand hygiene during all line manipulations.
Question 4: A patient is ordered Lactated Ringer's (LR) solution. Which patient condition is a contraindication for this fluid?
- Dehydration from diarrhea
- Burn injuries
- Severe liver disease (Correct answer)
- Mild hemorrhage
Correct answer: Severe liver disease
LR contains lactate that must be metabolized by the liver; patients with severe liver disease cannot convert lactate to bicarbonate, risking lactic acidosis.
Question 5: An LVN is assessing IV catheter patency. When aspirating a peripheral IV, blood return confirms patency, but which additional sign also confirms the catheter is in the vein?
- Pain during aspiration
- Resistance during a gentle saline flush
- Free-flowing flush without swelling or resistance (Correct answer)
- Coolness at the site during flushing
Correct answer: Free-flowing flush without swelling or resistance
A freely flowing saline flush without resistance, swelling, or patient discomfort confirms that the catheter tip remains within the vein.
Question 6: A patient develops sudden chest pain, dyspnea, and a 'mill wheel' murmur shortly after a central line was accessed. Which complication should the LVN suspect?
- Pneumothorax
- Air embolism (Correct answer)
- Pulmonary embolism
- Hemothorax
Correct answer: Air embolism
A 'mill wheel' murmur (churning heart sound) is pathognomonic for air embolism caused by air entering the central venous circulation.
Question 7: Which assessment finding indicates a patient may be experiencing fluid volume deficit (dehydration)?
- Bounding pulse, hypertension, and periorbital edema
- Rapid weight gain of 2 kg in 24 hours
- Urine specific gravity of 1.030, tachycardia, and poor skin turgor (Correct answer)
- Crackles in lung bases and jugular vein distension
Correct answer: Urine specific gravity of 1.030, tachycardia, and poor skin turgor
Concentrated urine (high specific gravity), tachycardia, and poor skin turgor are classic signs of fluid volume deficit as the body attempts to retain water.
LVN IV Therapy & Fluid Management 5
A patient receiving 0.45% NaCl IV is at risk for which type of fluid shift?