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 problem. The bevel still sits against the inside wall of a catheter that has moved. A slow push shears the tip just as cleanly as a fast one.

Reinsert the needle and advance the catheter under low pressure: Low pressure has the same problem as going slowly. The shear happens because the needle edge meets plastic that is no longer seated on the needle. How hard you push does not matter.

Leave the catheter in place and attach tubing to test the flow: Testing the flow would make sense for a catheter that is fully in place. This catheter is halfway out and no longer reliably in the vein. Fluid run through this catheter goes into the tissue and delays the access this patient needs.

Leave the catheter in place and run fluid to keep the vein open: The firm, discolored swelling means this vein has been punctured and blood is already leaking into the tissue. Fluid run through this catheter goes into the tissue too and makes the hematoma bigger.

Apply a warm pack and attempt the same vein slightly higher up: A warm pack does not stop bleeding. Firm direct pressure is what stops bleeding from a punctured vein. This patient is on Eliquis and the swelling is still rising, so the site needs pressure now. Moving on to another attempt first leaves the hematoma growing.

Wrap the arm loosely and reattempt below the swelling in the hand: A loose wrap puts no real pressure on the site, so the bleeding keeps going. The hand is below the swelling and drains through the same punctured vein. Fluid run in the hand travels up that vein toward the heart and leaks out at the puncture into the hematoma.

Written orders from the sending physician for the pump settings: Written orders tell a provider what to do inside that provider's scope. A written order does not change what your certification allows, so the order cannot make a drug drip yours to run.

A second AEMT to watch the pump while the first drives the unit: A second AEMT adds another set of hands at the same level. Neither AEMT can adjust a drug infusion, so two AEMTs still cannot run the pump.

A telephone line to online medical direction for the rate changes: Online medical direction can guide decisions that are already inside your scope. A physician on the phone still cannot make a medicated infusion something you are certified to manage.

Halve the dose, because marrow absorbs faster than a vein does: Halving the dose because the route is different underdoses a patient who is barely breathing. The marrow empties into the same circulation the vein does. Nothing about the IO route calls for a smaller dose.

Double the dose, because marrow absorbs more slowly than a vein: Doubling the dose is wrong in the other direction. Once the drug is in the veins, there is no slower absorption to make up for.

Give the same dose, but only after the line has run for a minute: An IO line does need a flush to open the marrow before fluid will flow. After the flush, there is no waiting period before you can give a medication.

Raise the bag to the highest point in the patient compartment: Raising the bag helps when the whole line has low resistance and a little more gravity makes a difference. Here the clamp is fully open and the drip chamber is still slow. The 22-gauge catheter is the limit, and no bag height in the ambulance gets past that resistance.

Switch to macrodrip tubing and let the bolus run by gravity: Macrodrip tubing helps when the tubing itself is the narrow point, like with a larger catheter in a larger vein. This 2-year-old has a 22-gauge catheter in the hand. The catheter sets the limit, not the tubing, so new tubing changes nothing.

Squeeze the drip chamber by hand until the volume has gone in: Squeezing the drip chamber can force a little extra fluid through when you have nothing else. Squeezing pushes air and fluid in amounts you cannot predict. You have no reliable count of what went in, and this patient needs an exact bolus volume you can track.

Let both liters run and check a pressure after the second bag: With the clamp wide open, both liters run in before the first pressure check happens. One pressure after two liters tells you less than a full exam between each bolus.

Leave the line wide open, because the pressure is the priority: A normal blood pressure is not the goal in a patient who is still bleeding. Pushing the pressure up dilutes the clotting factors and can break up the clot at the bleeding site. Perfusion is the goal, and you check it between measured boluses. A wide open line with nobody watching gives you no reassessment at all.

Slow the line to a keep-vein-open rate until the hospital calls: D holds back the fluid this hypotensive patient needs. An active GI bleed with a low pressure calls for measured boluses, not a keep-vein-open rate.

Antecubital fossa (median cubital vein at the elbow crease): The median cubital vein at the elbow crease is big and easy to hit. The vein sits in the antecubital fossa, which is a joint. When the patient bends the elbow, the catheter can kink or tear the vein. Save the antecubital site for when you need fast, large-volume access. This patient only needs a line for routine medications.

A vein in the arm on the same side as a prior mastectomy with lymph node removal: Nothing else is wrong with this arm, and the vein may be easy to reach. Removing the lymph nodes during the mastectomy changed how lymph drains from that arm. Putting an IV in that arm raises the risk of lymphedema and infection. The whole arm is off limits, not just a second choice.

A vein located distal to a suspected forearm fracture site: A vein below a suspected forearm fracture may look usable. Starting an IV below the fracture risks fluid leaking into injured tissue. The leaking fluid adds to swelling that is already threatening circulation in that arm. Go above the fracture or use the other arm.

Macrodrip tubing, 10 gtt/mL: Macrodrip tubing at 10 gtt/mL is a real set. You use it to push fluid fast, like a bolus for an adult in hemorrhagic shock. This question asks for a slow, precisely controlled infusion in a child. Macrodrip drops are too big to fine tune a slow rate in a small patient.

Macrodrip tubing, 20 gtt/mL: Macrodrip tubing at 20 gtt/mL is the standard set for routine adult fluids. The drops are still too big. A macrodrip set cannot hold the slow, fine rate this child's infusion needs.

Microdrip tubing, 15 gtt/mL: Microdrip is the right kind of tubing, but the drop factor is wrong. Standard microdrip tubing is always 60 gtt/mL, never 15. A 15 gtt/mL drop factor belongs to a macrodrip set. Option D mixes up the two kinds of tubing.

The right proximal tibia: the standard landmark in adults and children. The flat spot below the tibial tuberosity is easy to find, and in almost any other patient that spot would be a good choice. What rules it out here is the prosthetic right knee. The hardware sits directly above that landmark and disrupts the marrow space and drainage the needle depends on. Use the same landmark on the left leg, which has no hardware in it.

The right proximal tibia, at a slower flow rate: Slowing the flow rate treats a hardware problem like a rate problem. A marrow cavity disrupted by a prosthesis does not drain at any rate. A slower infusion still leaks into the tissue, just more slowly. The medication also gets delivered unreliably, and this patient needs it to work. Switching to the left leg gets rid of the problem completely.

Continue peripheral attempts instead of using an IO: More peripheral attempts make sense in a stable patient when a vein is likely to be found. This patient is unresponsive, poorly perfused, and needs medication, and three attempts have already failed. At that point the intraosseous route is indicated, not optional. More peripheral attempts only delay the medication, and a good site is open on the left leg.

Start the infusion, then draw back through the catheter: Once fluid has run, the blood in and around the catheter is mixed with it. A sample drawn back through the same catheter is diluted. Diluted samples like this are the most common reason a prehospital sample gets thrown out at the hospital.

Draw the samples from a vein above the running line: Drawing from a vein above the running line has the same problem as drawing back through the catheter. Fluid is flowing toward that spot, so the sample gets diluted. If you ever have to draw with fluid already running, use the opposite arm. Here nothing has been connected yet, so you do not need a workaround.

Skip the samples, since sampling is above AEMT scope: Venous blood sampling is within the AEMT scope of practice, not above it. Skipping the samples for scope reasons gives up a diagnostic step you are expected to perform. The hospital ends up with a later sample that is already diluted.