24+ PNLE IV Therapy Nursing Questions Study Guide and Review Materials
Introduction
IV Therapy can feel like a walk in a med-surg park—until it's not. You don't want terms like "infiltration," "extravasation," or "phlebitis" to catch you off guard when the stakes are high. This is not just another topic; it often comes with clinical scenarios that weave in and out of other subjects like OB, cardiac disorders, and mental health.
On the PNLE, expect questions about IV Therapy to dive into patient safety, reaction monitoring, and proper nursing interventions. You'll often need to decide what to monitor and when, as well as which complications demand immediate action. Understanding the nuances between different types of IV complications is key, and many students trip over this.
Why should you care? Because when you're on the floor, this knowledge isn't just for passing an exam—it's for keeping patients safe. Stick around, and you'll not only know what to study but how to ace those test questions.
Key concepts
What to expect on the PNLE
Expect around 2-4 questions on IV therapy in the PNLE, often blending into patient safety and drug monitoring scenarios. The questions are a mix of recall and application, mostly asking you to assess and decide on actions based on given symptoms.
- Clinical scenario frequency: You'll frequently encounter scenarios requiring you to identify complications like infiltration or phlebitis and apply nursing interventions.
- Priority Decisions: You'll make priority calls on stopping medications or procedures based on critical indicators like sudden swelling or respiratory changes.
- Trap alert: A common trick is to give an option that's technically right, like applying a warm compress generally, but not first priority in an emergency situation. Always align with patient safety first.
Knowing this can make you feel like you've got a sneak peek into the exam. When you know what to expect, you just have to practice tackling it efficiently.
Study tips
- IV Complications Chart: Create a simple chart listing complications like infiltration, extravasation, and phlebitis. Include signs, symptoms, and interventions for each. This visual aid helps compare and contrast the details.
- Use Mnemonics for Signs and Symptoms: Mnemonics like RICE (Rest, Ice, Compression, Elevation) for managing infiltration can stick in your mind better than lists.
- Role Play Scenarios: Pair up with a study buddy and take turns playing nurse and patient. Act out scenarios involving IV complications and nursing actions, and you'll remember the material more organically.
- Watch Videos of IV Insertions and Complication Management: Find reliable nursing channels online. Seeing the actions will reinforce what you've read.
- Quiz Yourself with Practice Questions: Go through IV therapy-related practice questions on tangerine. This helps test your recall and application skills.
Common mistakes to avoid
- Ignoring Subtle Signs of Infiltration: "You see a patient with a slightly swollen and cool IV site. Naturally, your gut says it's not serious. But the PNLE loves this. When you see these signs, you should think infiltration and stop the infusion to prevent tissue damage."
- Confusing Phlebitis with Cellulitis: "The exam has a scenario where an IV site is red, warm, and painful. It screams 'infection!' but you think cellulitis. Phlebitis is the correct diagnosis. Remember, cellulitis involves deeper skin layers, which isn't specified here."
- Forgetting Antidotes: "You get a question on magnesium sulfate toxicity and panic about treatments. Calcium gluconate should be your top answer. Many forget this during the exam."
- Misjudging Priorities in Hypotension: "Patient has hypotension post-epidural and you're convinced it's time for medication. The exam wants positioning first, like lying the patient flat, to manage low BP effectively."
Try a question
A real IV Therapy question from our bank. Give it a shot.
In pneumonia, plasma chlorides tend to fall. Which nursing/medical intervention is recommended to correct this imbalance?
In pneumonia, patients can develop hypochloremia (low serum chloride). Chloride is the major extracellular anion and is closely linked with sodium balance, osmolality, and acid base regulation. When plasma chloride falls, the most direct corrective approach is to replace chloride, typically by giving sodium chloride (NaCl) orally if the patient can tolerate it, or intravenously if they cannot or if the deficit is clinically significant.
Why sodium chloride replacement is recommended
Normal saline (0.9% NaCl) provides both sodium and chloride, addressing the underlying deficit and supporting extracellular fluid volume. In respiratory infections like pneumonia, chloride may drop due to:
- Poor intake (anorexia, fatigue)
- Gastrointestinal losses (vomiting from coughing, antibiotics, fever related stress)
- Dilutional effects when hypotonic fluids or excessive free water are given
- Compensatory shifts in acid base status, since chloride participates in maintaining electroneutrality and bicarbonate balance
Nursing priorities include confirming the electrolyte pattern, assessing volume status, and monitoring for complications (changes in mental status, weakness, dysrhythmia risk when multiple electrolytes are abnormal). When hypochloremia is present, standard med surg teaching emphasizes chloride repletion, most commonly with NaCl, while continuing to manage pneumonia (oxygenation, antibiotics, airway clearance).
Why the other options are incorrect
| Option | Why it is wrong |
|---|---|
| A. Strict fluid restriction to prevent edema | Fluid restriction is not a primary treatment for isolated low chloride. Restricting fluids can worsen dehydration and thickened secretions, impairing airway clearance in pneumonia. Fluid restriction is typically reserved for conditions like severe heart failure or certain hyponatremia syndromes, guided by assessment and labs. |
| B. Withhold electrolytes until laboratory confirmation | Chloride imbalance is identified by labs, but once hypochloremia is known, withholding replacement delays correction. Appropriate care is to trend electrolytes and replace as ordered, not to stop all electrolytes reflexively. |
| D. Administer potassium chloride only | Potassium chloride treats hypokalemia and can provide chloride, but giving KCl “only” is unsafe and incorrect unless potassium is also low and replacement is indicated. Unnecessary KCl risks hyperkalemia and dysrhythmias. Most hypochloremia without hypokalemia is corrected with NaCl, not potassium. |
Clinical pearls for exams
- Think: Low chloride, replace chloride, most often with normal saline.
- Tie chloride to acid base: low chloride can be associated with metabolic alkalosis (classically from vomiting or gastric suction). In such cases, chloride responsive alkalosis improves with NaCl.
- In pneumonia, avoid interventions that worsen secretion clearance, inadequate hydration can make sputum thicker.
What the question is testing
This item checks your ability to link a common lab trend (falling chloride) with the appropriate corrective fluid and electrolyte therapy, using safe clinical reasoning and avoiding high risk replacements without indication.
Hinkle, J.L., & Cheever, K.H. (2022). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (15th ed.). Wolters Kluwer.
Ignatavicius, D.D., Workman, M.L., Rebar, C.R., & Heimgartner, N.M. (2021). Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care (10th ed.). Elsevier.
Pagana, K.D., Pagana, T.J., & Pagana, T.N. (2021). Mosby’s Diagnostic & Laboratory Test Reference (15th ed.). Elsevier.
Widmaier, E.P., Raff, H., & Strang, K.T. (2019). Vander’s Human Physiology: The Mechanisms of Body Function (15th ed.). McGraw-Hill Education.
Merck Manual Professional Edition (2024). Metabolic Alkalosis: Treatment (chloride-responsive alkalosis treated with IV 0.9% saline; potassium as indicated). Merck & Co., Inc.
Oh, H.J., Kim, S.J., Kim, Y.C., et al. (2017). An increased chloride level in hypochloremia is associated with decreased mortality in patients with severe sepsis or septic shock. Scientific Reports, 7, 15883.
More IV Therapy questions
29+ questions available. Sign up to practice all of them.
A patient with dengue develops signs of circulatory compromise (narrow pulse pressure, cold clammy skin, low blood pressure). Which immediate nursing intervention is the most important to prevent death?
Which of the following actions is contraindicated when providing first-aid care to an unconscious pregnant woman in the field?
Joy, an obese 32 year-old, is admitted to the hospital after an automobile accident. She has a fractured hip and is brought to the OR for surgery. After surgery, Joy is to receive a piggy-back of Clindamycin phosphate (Cleocin) 300 mg in 50 ml of D5W. The piggyback is to infuse in 20 minutes. The drop factor of the IV set is 10 gtt/ml. The nurse should set the piggyback to flow at:
Practice questions
Q: A patient receiving IV therapy complains of pain and swelling at the site, with noticeable erythema along the vein. What's the most appropriate initial nursing action?
Answer: C. Discontinuing the IV line is crucial to prevent further irritation in phlebitis. D is tempting as soothing, but stopping the infusion takes priority. View more questions
Q: After administering magnesium sulfate, a patient shows decreased deep tendon reflexes. What should the nurse prepare to administer?
Answer: A. Calcium gluconate reverses magnesium sulfate toxicity. Potassium chloride and sodium bicarbonate won't correct this specific issue. View more questions
Q: During IV therapy, the patient reports a burning sensation and the nurse observes blanched, taut skin at the site. What's the priority action?
Answer: C. The signs suggest extravasation, requiring immediate cessation of the IV to prevent tissue damage. Elevating the arm doesn't address the core issue. View more questions
Q: A patient receiving Oxytocin infusion for labor induction shows signs of fetal distress. What should the nurse do first?
Answer: B. Stopping the Oxytocin addresses the root cause of fetal distress immediately. Although others help, discontinuing the medication is urgent. View more questions
Q: A patient with a hypotensive episode after an epidural should be managed how?
Answer: C. Clinically, repositioning flat aids in circulation before considering medications. A quick decision that prioritizes circulation can stabilize this condition. View more questions
References and further reading
- Intravenous Fluid Therapy in Adults in Hospital guideline
This guideline from the National Institute for Health and Care Excellence (NICE) provides comprehensive recommendations on IV fluid therapy, including prescribing, monitoring, and training for healthcare professionals. - Intravenous Therapy: Preparation and Administration of IV Medicines journal
This article reviews the preparation and administration of IV therapy, outlining safe standards of practice for nurses. - IV: Recommendations | Infection Control | CDC government
The CDC provides guidelines on infection control practices related to intravenous therapy, emphasizing the importance of using sterile, single-use items and proper administration sets. - Chapter 23 IV Therapy Management - Nursing Skills educational
This chapter offers detailed information on IV therapy management, including assessment, monitoring, and potential complications, serving as an educational resource for nursing students and professionals. - Intravenous Therapy: A Guide to Good Practice journal
This article provides an overview of the principles of good practice that underpin intravenous therapy, including indications, device selection, and infection control. - The Practice of IV Therapy by Licensed Practical Nurses (LPNs) - Essential Course Content educational
This resource outlines essential course content for LPNs practicing IV therapy, covering topics such as patient safety, infection control, and patient monitoring. - IV Treatment at Home: MedlinePlus Medical Encyclopedia educational
MedlinePlus provides information on administering IV treatments at home, including the types of catheters used and reasons for home IV therapy.