Nremt Aemt Level Quiz: Iv Io Access And Fluid Therapy

What this quiz covers

This quiz focuses on Iv Io Access And Fluid Therapy, giving you a quick way to practice the rules, question types, and explanations that matter most for Nremt Aemt Level.

How to use this quiz

Try each quiz question before looking at the correct answer. Use the explanations to review missed ideas, then come back to similar questions until the pattern feels familiar.

Question 1

1. A single 20-gauge IV in the hand with a 500 mL bolus of 0.9% Normal Saline.
2. Two large-bore (16- or 18-gauge) IVs in the antecubital fossae with Lactated Ringer's administered wide open. (correct answer)
3. An external jugular IV with D5W administered at a TKO rate until hospital arrival.
4. An IO in the unaffected tibia with 0.45% Normal Saline to rapidly increase circulatory volume.

Explanation: This patient is in hemorrhagic shock. The standard of care is to establish two large-bore IVs for rapid volume replacement. The antecubital fossae are preferred sites for large catheters. Lactated Ringer's is an appropriate isotonic crystalloid for trauma resuscitation.

Question 2

1. To restore blood pressure to a normal level of 120/80 mmHg.
2. To achieve permissive hypotension with a systolic BP of 80-90 mmHg. (correct answer)
3. To dilute circulating toxins released from crushed tissues.
4. To reverse metabolic acidosis by providing lactate as a buffer.

Explanation: In trauma with suspected uncontrolled internal hemorrhage, the goal is 'permissive hypotension' or 'hypotensive resuscitation.' The aim is to administer just enough fluid to maintain vital organ perfusion (indicated by a palpable radial pulse or a systolic BP of 80-90 mmHg) without raising the pressure so high that it disrupts clot formation and worsens bleeding. Restoring a normal BP is contraindicated as it can 'pop the clot.'

Question 3

1. To increase hemoglobin concentration for better oxygen delivery to tissues.
2. To increase intravascular volume and improve cardiac preload, thereby increasing blood pressure. (correct answer)
3. To decrease the heart rate by stimulating the parasympathetic nervous system.
4. To flush inflammatory mediators from the microcirculation and reduce the septic response.

Explanation: In septic shock, widespread vasodilation and capillary leakage lead to relative hypovolemia. A fluid challenge (bolus) is given to rapidly increase the volume of fluid within the blood vessels. This increases venous return to the heart (preload), which, according to the Frank-Starling mechanism, increases stroke volume and cardiac output, ultimately improving blood pressure and tissue perfusion.

Question 4

1. IV fluids should be withheld until the effects of epinephrine are fully realized.
2. A maintenance rate of D5W should be started to support blood glucose levels.
3. Aggressive fluid resuscitation with an isotonic crystalloid should be initiated immediately. (correct answer)
4. A saline lock is sufficient as fluid shifts are not a major feature of anaphylaxis.

Explanation: In anaphylactic shock, massive vasodilation and capillary leakage cause a profound drop in blood pressure and relative hypovolemia. Along with epinephrine, aggressive IV fluid resuscitation with an isotonic crystalloid (like 0.9% NS or LR) is critical to fill the expanded vascular space and support blood pressure. Withholding fluids or using a maintenance rate is inadequate.

Question 5

1. 120 mL
2. 200 mL
3. 240 mL (correct answer)
4. 360 mL

Explanation: The calculation is based on the child's weight and the ordered dose per kilogram. Weight (12 kg) × Dose (20 mL/kg) = 240 mL. The AEMT must be able to accurately calculate weight-based fluid boluses for pediatric patients.

Question 6

1. Administer a rapid 500 mL bolus of an isotonic crystalloid to ensure patency.
2. Attach a pressure infusion bag to the saline flush to overcome intramedullary pressure.
3. Administer a slow push of 2% lidocaine per protocol for pain management. (correct answer)
4. Lower the IO needle by one centimeter to ensure it is seated in the marrow cavity.

Explanation: IO infusion can be extremely painful in a conscious patient. After confirming placement, standard protocol often involves administering 2% preservative-free lidocaine into the IO space prior to the main infusion to anesthetize the bone marrow cavity and reduce patient discomfort. A pressure bag is used for the infusion itself, not the flush. A large bolus is not the next step, and the needle should not be manipulated after insertion.

Question 7

1. Lactated Ringer's, because its buffer will help correct the severe metabolic acidosis.
2. 0.9% Normal Saline, because it does not contain potassium, which is likely already elevated. (correct answer)
3. D5W, because the patient is likely hypoglycemic due to their chronic illness.
4. 0.45% Normal Saline, to rapidly shift fluid into the intracellular space and correct dehydration.

Explanation: Patients with ESRD are unable to excrete potassium, leading to chronic hyperkalemia, which is often the cause of their cardiac arrest. Lactated Ringer's contains potassium and would be contraindicated. 0.9% Normal Saline does not contain potassium and is the safest isotonic crystalloid for volume expansion in this patient population. D5W is hypotonic and not a resuscitation fluid. 0.45% saline is also hypotonic and inappropriate for resuscitation.

Question 8

1. A patient who is awake and able to feel pain at the insertion site.
2. Presence of a functioning peripheral IV in the contralateral limb.
3. A previous, healed surgical procedure near the intended insertion site.
4. A fracture in the same bone proximal to the intended insertion site. (correct answer)

Explanation: Placing an IO distal to a fracture in the same bone is an absolute contraindication because the infused fluid will leak from the fracture site into the soft tissues, leading to extravasation and potential compartment syndrome, and will not enter central circulation. Pain can be managed with lidocaine. A contralateral IV does not preclude IO placement. A healed surgical site is a relative, not absolute, contraindication.

Question 9

1. Establish an 18-gauge IV and administer a 500 mL bolus of 0.9% Normal Saline, then reassess vital signs. (correct answer)
2. Administer a 1-liter bolus of Lactated Ringer's as quickly as possible using a 16-gauge IV catheter.
3. Start an IV of D5W at a keep-vein-open rate to correct dehydration without raising blood pressure too quickly.
4. Place a 22-gauge IV and administer a 250 mL bolus of 0.9% Normal Saline over 30 minutes to avoid fluid overload.

Explanation: The patient is hypotensive and tachycardic, indicating significant hypovolemia. An initial bolus is warranted. However, in geriatric patients, aggressive fluid resuscitation must be balanced with the risk of fluid overload and congestive heart failure. A 500 mL bolus is a prudent starting point, followed by reassessment. 0.9% Normal Saline is an appropriate isotonic crystalloid for this situation.

Question 10

1. 42 gtt/min
2. 83 gtt/min (correct answer)
3. 125 gtt/min
4. 167 gtt/min

Explanation: The calculation is: (Total Volume in mL × Drip Factor in gtt/mL) / Time in minutes. (1000 mL × 10 gtt/mL) / 120 minutes = 10000 / 120 = 83.33 gtt/min. The closest answer is 83 gtt/min. The other answers represent common calculation errors, such as dividing by 60 minutes instead of 120 or using the wrong volume.

Question 11

1. Phlebitis; apply a warm compress to the site and continue the infusion.
2. Catheter shear; immediately apply a tourniquet proximal to the IV site.
3. Infiltration; discontinue the infusion and remove the IV catheter. (correct answer)
4. Venous spasm; lower the IV bag to slow the infusion rate temporarily.

Explanation: The signs of swelling, coolness, and tightness with a stopped flow are classic indicators of infiltration, where the IV fluid is leaking into the surrounding tissue. The primary action is to stop the infusion, remove the catheter, and apply pressure to the site. Phlebitis involves warmth and redness. Catheter shear is a rare and serious complication but presents differently. A venous spasm would likely cause pain along the vein.

Question 12

1. Attempt to place an external jugular vein catheter.
2. Administer epinephrine via the endotracheal tube.
3. Continue attempts at peripheral access in the lower extremities.
4. Establish intraosseous (IO) access in the proximal tibia. (correct answer)

Explanation: In cardiac arrest, when peripheral IV access is difficult or delayed, intraosseous (IO) access is the recommended next step. It provides rapid, reliable access to the vascular system for medication and fluid administration. External jugular access is a difficult skill, and ET administration is no longer the preferred route due to unreliable absorption. Further peripheral attempts waste critical time.

Question 13

1. Remove the tourniquet and attempt to flush the catheter with saline to confirm placement.
2. Continue to advance and retract the catheter in a 'fishing' motion until a flash is obtained.
3. Remove the catheter and needle completely and apply pressure to the site. (correct answer)
4. Attach the IV tubing and start the fluid, observing for any signs of infiltration.

Explanation: If a flashback is not obtained, the catheter is not properly seated in the vein. Probing or 'fishing' for the vein increases the risk of vessel damage, hematoma, and infiltration. Flushing a misplaced catheter will cause infiltration. Starting the fluid without confirmation of placement is unsafe. The correct procedure is to accept the attempt as unsuccessful, remove the device, apply pressure, and choose a new site.

Question 14

1. Administer a 500 mL bolus of 0.9% Normal Saline to treat the tachycardia.
2. Establish a saline lock for medication access but withhold fluid administration. (correct answer)
3. Start a microdrip infusion of D5W to provide calories and hydration.
4. Place a large-bore IV and administer Lactated Ringer's to decrease cardiac preload.

Explanation: This patient is in cardiogenic shock secondary to CHF and is fluid overloaded, as evidenced by lung crackles, JVD, and edema. Administering a fluid bolus would worsen the pulmonary edema and respiratory distress. The most appropriate action is to establish IV access for potential medication administration (e.g., diuretics, vasodilators) but to withhold fluids. A saline lock achieves this without delivering unnecessary volume.

Question 15

1. 0.45% Normal Saline to reduce cerebral cell size.
2. 5% Dextrose in Water (D5W) as it is metabolically neutral.
3. Lactated Ringer's because it is the most physiologically balanced crystalloid.
4. 0.9% Normal Saline to correct hypotension without causing cerebral edema. (correct answer)

Explanation: In a patient with a head injury, it is critical to avoid hypotonic solutions (like 0.45% NS and D5W), as they can increase free water in the circulation, which can cross the blood-brain barrier and worsen cerebral edema. Lactated Ringer's is slightly hypotonic and generally avoided. 0.9% Normal Saline is isotonic and is the preferred crystalloid for resuscitating a hypotensive patient with a suspected head injury, as it helps maintain cerebral perfusion pressure without increasing ICP.

Question 16

1. Air embolism
2. Infiltration
3. Phlebitis (correct answer)
4. Systemic infection

Explanation: The classic signs of phlebitis (inflammation of the vein) are pain, erythema (redness), edema, and warmth along the vein's path. Sometimes a palpable venous cord is also present. Infiltration presents with coolness and swelling at the site. An air embolism and systemic infection would present with systemic signs and symptoms, not localized findings along the vein.

Question 17

1. It is a hypertonic solution that would cause hemolysis of red blood cells.
2. Its acidic pH can damage the cellular membrane of transfused erythrocytes.
3. It contains potassium, which can lead to hyperkalemia when given with stored blood.
4. It contains calcium, which may bind to the citrate anticoagulant in blood products and cause clotting. (correct answer)

Explanation: Lactated Ringer's solution contains calcium. Blood products are preserved with citrate, which acts as an anticoagulant by binding to calcium. If LR is administered through the same line as blood, the calcium in the LR can overcome the citrate, potentially causing the blood to clot in the IV tubing. For this reason, 0.9% Normal Saline is the only crystalloid recommended for co-administration with blood products.