1Question
An older adult with heart failure is receiving an intravenous infusion at a rapid rate. Which findings suggest circulatory overload?
Select all that apply.
- Crackles at both lung bases
- A bounding pulse
- Distended jugular veins
- A weight gain of 2 kg overnight
- Flat neck veins
- A weak, thready pulse with a low blood pressure
Show the answers and explanation
Answers: A, B, C and D.
- A – Crackles at both lung bases
- B – A bounding pulse
- C – Distended jugular veins
- D – A weight gain of 2 kg overnight
Topic: IV fluid circulatory overload
Too much fluid too fast raises the blood volume and pressure in the circulation, so lung crackles, a bounding pulse, distended neck veins and a rapid weight gain appear. Flat neck veins and a weak thready pulse with low pressure point to too little volume.
Why the others are wrong
- E – Flat neck veins are a sign of low volume, not of overload.
- F – A weak thready pulse with low blood pressure is a sign of hypovolemia or shock.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
2Question
A client who receives hemodialysis through a left forearm arteriovenous fistula needs a peripheral IV catheter for an antibiotic. Where should the nurse place the catheter?
- In a vein on the back of the left hand
- In the left upper arm above the fistula
- In a vein of the right forearm
- In the left antecubital fossa
Show the answer and explanation
Answer: C. In a vein of the right forearm
Topic: IV site selection with a fistula
The arm with a dialysis fistula is protected from venipuncture, IV catheters and blood pressure cuffs because needle sticks can cause clotting, infection or loss of the access. The opposite arm is used, preferring distal veins and sparing the veins of the forearm that may be needed for a future fistula.
Why the others are wrong
- A – Any procedure in the fistula arm risks clotting, infection or damage to the access.
- B – Upper arm veins above the fistula are in the protected arm too.
- D – The left antecubital vein lies in the fistula arm and is also needed later for blood draws; it is avoided.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
3Question
A client with a serum sodium of 118 mEq/L and a seizure is receiving 3% sodium chloride through a central line. Which nursing action is the priority?
- Obtain a daily weight at the same time each morning and compare it with the previous day
- Infuse the solution by gravity so that the rate adjusts to the client's tolerance
- Check the serum sodium often and report a rise faster than the ordered rate
- Keep the client flat in bed for 24 hours to prevent further seizures
Show the answer and explanation
Answer: C. Check the serum sodium often and report a rise faster than the ordered rate
Topic: 3% sodium chloride monitoring
Hypertonic saline is a high-alert drug given by pump at a controlled rate. Raising sodium too quickly can cause osmotic demyelination of brain cells, so serum sodium is checked frequently and any overly rapid rise is reported.
Why the others are wrong
- A – Daily weights are useful but far too infrequent to catch an over-rapid sodium rise.
- B – A high-alert infusion needs an electronic pump to control the rate exactly.
- D – Bed rest flat has no effect on sodium or seizures; seizure precautions and safety are done instead.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
4Question
A nurse is setting up maintenance intravenous fluids for an 8-month-old infant. Which action is most important for the infant's safety?
- Hang a 1,000 mL bag so that the container needs changing less often, and check the drip rate every hour
- Use macrodrip tubing so that the line is less likely to occlude
- Run the fluid through an infusion pump using a volume-control chamber that holds only a small, limited volume at a time
- Give the first hour's fluid faster than prescribed, then slow the rate, to make up for the time the infant was fasting
Show the answer and explanation
Answer: C. Run the fluid through an infusion pump using a volume-control chamber that holds only a small, limited volume at a time
Topic: safe IV fluid delivery in infants
An infant has a small circulating volume and immature kidneys, so a small excess of fluid given quickly can cause overload. Fluids for infants are delivered by an infusion pump with a volume-control device, so that only a limited amount could ever run in by accident, and the site and the volume infused are checked at least hourly.
Why the others are wrong
- A – A large container on gravity means the whole liter could run in if the clamp slips or the infant moves; hourly checks do not prevent that.
- B – Macrodrip tubing delivers large drops and makes small hourly volumes hard to control; infants need microdrip or pump control.
- D – Changing the prescribed rate is outside the order and a rapid extra volume is exactly what overloads an infant.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
5Question
A client is receiving doxorubicin, a vesicant, through a peripheral intravenous catheter. The client reports burning at the site, and the nurse sees swelling and no blood return. Which action should the nurse take first?
- Slow the infusion and apply a warm compress
- Flush the catheter briskly with 0.9% sodium chloride
- Remove the catheter at once and apply firm pressure
- Stop the infusion and leave the catheter in place so that residual drug can be aspirated
Show the answer and explanation
Answer: D. Stop the infusion and leave the catheter in place so that residual drug can be aspirated
Topic: extravasation versus infiltration versus phlebitis
Leakage of a vesicant into tissue is extravasation and can cause blistering and necrosis. The infusion is stopped immediately; the catheter is left in at first so that drug can be drawn back and an antidote given if the protocol calls for one, and the provider is notified. Infiltration is the leak of a non-vesicant fluid (cool, pale, swollen site), and phlebitis is inflammation of the vein (red, warm, cord-like), and in those the catheter is simply removed.
Why the others are wrong
- A – Any continued infusion delivers more vesicant into the tissue.
- B – Flushing drives the drug further into the tissue.
- C – Removing the catheter straight away loses the route for aspiration and antidote, and pressure spreads the drug.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
6Question
The nurse reviews new intravenous fluid prescriptions for four clients. Which prescription should the nurse question?
- 0.45% sodium chloride for a client with a head injury and signs of increased intracranial pressure
- 0.9% sodium chloride for a client with fluid volume deficit after two days of vomiting
- Lactated Ringer's solution for a client in the first hours after a major burn
- 3% sodium chloride by infusion pump with frequent sodium checks for a client with severe symptomatic hyponatremia
Show the answer and explanation
Answer: A. 0.45% sodium chloride for a client with a head injury and signs of increased intracranial pressure
Topic: isotonic, hypotonic and hypertonic fluids
A hypotonic solution moves water out of the vessels and into cells, including brain cells, and so worsens cerebral edema. It is not given to a client with raised intracranial pressure. Isotonic solutions expand the vascular volume in dehydration and burns, and hypertonic saline, given slowly on a pump with close monitoring, is the treatment for severe symptomatic hyponatremia.
Why the others are wrong
- B – Isotonic saline replaces the volume lost through vomiting.
- C – Lactated Ringer's is a standard isotonic fluid for burn resuscitation.
- D – Hypertonic saline with a pump and frequent sodium levels is appropriate for severe symptomatic hyponatremia.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
7Question
A client's serum potassium is 2.9 mEq/L. The prescription reads: "Potassium chloride 20 mEq IV push now." Which action should the nurse take?
- Give the dose slowly over five minutes while watching the cardiac monitor
- Dilute the dose in 10 mL of 0.9% sodium chloride and give it through a central line
- Give the dose by mouth instead, as the oral route is safer
- Withhold the dose and contact the prescriber to change it to a diluted infusion given by pump
Show the answer and explanation
Answer: D. Withhold the dose and contact the prescriber to change it to a diluted infusion given by pump
Topic: potassium chloride never IV push
Potassium chloride is never given by intravenous push: a concentrated bolus can stop the heart. Intravenous potassium is always diluted and infused at a controlled rate through a pump, with monitoring. The nurse does not carry out an unsafe order and does not change the route independently, but has the prescription corrected.
Why the others are wrong
- A – Five minutes is still a bolus and can cause a fatal dysrhythmia.
- B – A small dilution given by push is still a concentrated bolus, whatever the line.
- C – The nurse cannot change the route without a new prescription.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
8Question
A client in septic shock has dopamine infusing through a peripheral IV catheter in the forearm while central access is being arranged. The nurse finds the skin around the site blanched, cool and swollen. Which action should the nurse take first?
- Apply a warm compress to the area and recheck it in 15 minutes.
- Stop the infusion at once, leave the catheter in place, and notify the provider.
- Flush the catheter with saline to clear the medication out of the tissue.
- Lower the rate by half and elevate the arm above the heart.
Show the answer and explanation
Answer: B. Stop the infusion at once, leave the catheter in place, and notify the provider.
Topic: vasopressor extravasation
Dopamine is a vasoconstrictor. Leaking into tissue causes severe vasospasm, ischemia, and tissue death. The nurse stops the infusion immediately, leaves the catheter in place so residual drug can be aspirated and an antidote such as phentolamine can be given as ordered, and notifies the provider. Flushing would push more drug into tissue.
Why the others are wrong
- A – Waiting to recheck while the drug still infuses allows further tissue damage.
- C – Flushing pushes more of the drug into the tissue and enlarges the injury.
- D – Slowing the rate still delivers vasopressor into the tissue; the infusion must be stopped.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
9Question
A client has an order for cefazolin 2 g IV piggyback to infuse over 30 minutes. The pharmacy sends 2 g in 100 mL of normal saline. At what rate will the nurse set the infusion pump?
- 20 mL/hour
- 100 mL/hour
- 200 mL/hour
- 400 mL/hour
Show the answer and explanation
Answer: C. 200 mL/hour
Topic: intermittent infusion pump rate
Pumps are set in mL/hour. If 100 mL runs in 30 minutes, then 200 mL would run in 60 minutes, so the rate is 200 mL/hour.
Why the others are wrong
- A – This is a decimal-place error that would take five hours.
- B – This would take 60 minutes rather than 30.
- D – This would empty the bag in 15 minutes, which is too fast.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
10Question
A provider orders 500 mL of 0.9% sodium chloride to infuse over 4 hours by gravity. The tubing delivers 15 drops per milliliter. How many drops per minute should the nurse set? Express the answer as a whole number.
- 125 drops per minute
- 33 drops per minute
- 31 drops per minute
- 29 drops per minute
Show the answer and explanation
Answer: C. 31 drops per minute
Topic: gravity drip rate
Drops per minute equals volume times drop factor divided by minutes: 500 x 15 / 240 = 31.25, which rounds to 31 drops per minute.
Why the others are wrong
- A – 125 is the milliliters per hour rate, not drops per minute.
- B – 33 comes from rounding or arithmetic errors in the calculation.
- D – 29 results from a calculation error and would run the fluid too slowly.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
11Question
A provider orders a 500 mL bolus of 0.9% sodium chloride to infuse over 45 minutes by infusion pump. What rate in milliliters per hour should the nurse set on the pump? Express the answer as a whole number.
- 375 mL/hour
- 500 mL/hour
- 11 mL/hour
- 667 mL/hour
Show the answer and explanation
Answer: D. 667 mL/hour
Topic: pump rate from minutes
The rate in mL/hour equals the volume divided by the time in hours. 45 minutes is 0.75 hour, and 500 / 0.75 = 666.7, or 667 mL/hour.
Why the others are wrong
- A – 375 multiplies 500 by 0.75 instead of dividing.
- B – 500 mL/hour would take a full hour, not 45 minutes.
- C – 11 divides the volume by the minutes, which gives milliliters per minute, not per hour.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
12Question
A client with three days of vomiting and diarrhea has a serum osmolality of 318 mOsm/kg. Which additional finding should the nurse expect?
- Pale, abundant urine with a low specific gravity
- Bounding pulse with crackles in the lung bases
- Dark, scant urine with a high specific gravity
- Jugular vein distention with weight gain
Show the answer and explanation
Answer: C. Dark, scant urine with a high specific gravity
Topic: serum osmolality and urine concentration
A serum osmolality above the usual range of about 275 to 295 mOsm/kg after fluid losses reflects water deficit. Antidiuretic hormone is released and the kidneys conserve water, producing small amounts of dark, concentrated urine with a high specific gravity.
Why the others are wrong
- A – Dilute urine would appear with excess water, not water loss.
- B – Those findings suggest fluid overload, the opposite of this picture.
- D – Distended neck veins and weight gain point to volume excess.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
13Question
A client with hypovolemia from blood loss is receiving 0.9% sodium chloride. The client asks where the fluid goes in the body. Which explanation by the nurse is most accurate?
- “It moves quickly into the cells and swells them, which is how it restores the blood volume.”
- “It pulls fluid from the cells into the blood vessels, because it is more concentrated than blood.”
- “It stays only in the blood vessels, with no movement into any other space.”
- “It stays mainly in the fluid outside the cells, in the blood vessels and the spaces between cells.”
Show the answer and explanation
Answer: D. “It stays mainly in the fluid outside the cells, in the blood vessels and the spaces between cells.”
Topic: isotonic fluid distribution
About two thirds of body water is inside the cells and one third is outside them. Because 0.9% sodium chloride has the same osmolality as plasma, it stays in the extracellular compartment, expanding blood vessels and interstitial spaces without shifting water into or out of cells.
Why the others are wrong
- A – Cell swelling is the effect of hypotonic fluid, not isotonic solution.
- B – That is the action of a hypertonic solution.
- C – Isotonic saline also enters the interstitial space; it does not stay only in the bloodstream.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
14Question
A client with heart failure has gained 1.5 kg in 24 hours. The nurse hears new crackles in both lung bases, and the client is mildly short of breath. Which action should the nurse take first?
- Encourage extra oral fluids to help dilute the retained sodium
- Weigh the client again after lunch and wait for the next scheduled provider visit
- Lay the client flat to improve circulation to the kidneys
- Raise the head of the bed, check oxygen saturation, and notify the provider
Show the answer and explanation
Answer: D. Raise the head of the bed, check oxygen saturation, and notify the provider
Topic: fluid volume excess recognition and response
Rapid weight gain with new crackles and dyspnea indicates fluid volume excess and pulmonary congestion. Sitting upright eases breathing, oxygen saturation shows how serious the compromise is, and the provider needs to be told promptly so that diuretic therapy can be adjusted.
Why the others are wrong
- A – Fluids worsen volume overload.
- B – Delay risks progression to pulmonary edema.
- C – A flat position increases dyspnea in pulmonary congestion.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
15Question
A client with cirrhosis has a distended abdomen with a positive fluid wave. In which body fluid compartment is the excess fluid collecting?
- Intracellular fluid inside the cells of the liver and abdominal wall
- Intravascular plasma that circulates within the blood vessels
- Transcellular fluid within the peritoneal cavity
- Interstitial fluid that surrounds the cells of the abdominal wall
Show the answer and explanation
Answer: C. Transcellular fluid within the peritoneal cavity
Topic: transcellular fluid compartment
Transcellular fluid is found in specialized spaces such as the peritoneal, pleural, and pericardial cavities. Ascites is fluid trapped in the peritoneal cavity and is sometimes called third-space fluid, and it is not readily available to the circulation.
Why the others are wrong
- A – Fluid inside cells causes cell swelling, not a collection in the abdominal cavity.
- B – Plasma remains in the vessels, and fluid that has left the circulation is no longer intravascular.
- D – Interstitial fluid collects in tissues as edema, while ascites is free fluid within the peritoneal cavity.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
16Question
A client with 3 days of profuse watery diarrhea has an arterial pH of 7.30 and a serum bicarbonate of 16 mEq/L. Which explains these findings?
- Loss of bicarbonate-rich fluid from the intestine
- Loss of hydrochloric acid from gastric secretions
- Retention of carbon dioxide because of hypoventilation
- Excess production of ketone acids from fat breakdown
Show the answer and explanation
Answer: A. Loss of bicarbonate-rich fluid from the intestine
Topic: diarrhea and acid-base balance
Intestinal secretions are rich in bicarbonate, so prolonged diarrhea removes base and causes metabolic acidosis, with a low pH and low bicarbonate. Chloride is retained relatively, so the chloride level is often normal or high. Vomiting, not diarrhea, loses gastric acid.
Why the others are wrong
- B – Gastric acid is lost with vomiting and would cause alkalosis.
- C – CO2 retention causes respiratory acidosis with a high CO2, not a low bicarbonate.
- D – Ketoacidosis is possible in other conditions but is not suggested by a history of diarrhea.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
17Question
A client with an acute gastrointestinal hemorrhage is hypotensive, and the provider orders a 0.9% sodium chloride bolus. Why is an isotonic solution appropriate?
- It moves water into the cells to relieve cellular dehydration caused by the blood loss
- It stays in the extracellular space and expands intravascular volume
- It pulls fluid out of the interstitial space and into the cells to restore perfusion
- It supplies free water that is rapidly distributed equally to every body compartment
Show the answer and explanation
Answer: B. It stays in the extracellular space and expands intravascular volume
Topic: isotonic fluid and intravascular volume
Hemorrhage depletes the intravascular compartment. An isotonic crystalloid has the same tonicity as plasma, so it does not shift into cells and stays in the extracellular space, where it expands the intravascular volume and supports blood pressure until blood can be given.
Why the others are wrong
- A – Moving water into cells is the behavior of a hypotonic solution, which would not help vascular volume.
- C – Drawing fluid from the interstitial space into cells is not how isotonic fluids behave.
- D – Free water belongs to hypotonic fluids and would not stay in the vessels.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
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