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NCLEX-RN IV therapy practice questions

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These are original practice items written to the NCLEX-RN blueprint (4 options, no penalty for wrong answers), not actual exam questions. Try each one before you open the answer.

What this topic covers

IV therapy sits inside the Pharmacological and Parenteral Therapies category of the NCLEX-RN. Our bank holds 38 verified items tagged to it, and the 4 below are a fixed sample so the page stays the same every time you open it. Each one shows the reasoning, not just the letter.

The topic tag comes from our own items rather than from a published syllabus, so treat it as a map of what we cover. For the official category breakdown see the NCLEX-RN page.

IV therapy sample questions

Question 1

The nurse is caring for four clients on a medical-surgical unit. Which client requires the most immediate assessment?

  1. A A 65-year-old receiving IV antibiotics has new crackles in the lung bases and BP 100/68 mmHg.
  2. B A 60-year-old with IV 0.9% NaCl at 125 mL/hr has urine output 30 mL over 2 hours.
  3. C A 72-year-old with a central venous catheter has a temperature of 99.2°F.
  4. D A 68-year-old with a peripheral IV reports pain and redness at the insertion site.
Show the answer and explanation

Correct answer: A

New crackles in the lung bases suggest fluid in the alveoli, such as pulmonary edema from fluid overload, which threatens breathing and gas exchange. Following airway, breathing, and circulation priorities, this client needs assessment first.

Why the other options are wrong:
B: Urine output of 15 mL/hr is low and needs prompt follow-up, but it ranks after a new breathing problem.
C: A temperature of 99.2°F is only slightly elevated; it warrants monitoring for catheter infection but is not urgent.
D: Pain and redness at the IV site suggest phlebitis, which needs the site changed but is not life-threatening.

Question 2

A 48-year-old client in the post-anesthesia care unit has an IV of lactated Ringer solution infusing at 125 mL/hr via a peripheral IV in the left forearm. The nurse notes the site is cool to touch, the client reports pain at the insertion site, and there is moderate swelling of the surrounding tissue. The IV pump displays an occlusion alarm. Which nursing action is most appropriate?

  1. A Decrease the infusion rate to 75 mL/hr and apply a warm compress to the site.
  2. B Elevate the left arm and continue the infusion at the same rate after checking the alarm.
  3. C Flush the IV line with 3 mL of 0.9% sodium chloride using a push-pause technique.
  4. D Discontinue the IV and insert a new IV in the right forearm, then restart the infusion.
Show the answer and explanation

Correct answer: D

A cool, painful, swollen site with an occlusion alarm indicates infiltration: the catheter is no longer in the vein and fluid is entering the tissue. The nurse should discontinue the IV, then restart the infusion through a new site in the other arm.

Why the other options are wrong:
A: Slowing the rate still infuses fluid into the tissue because the catheter is out of the vein.
B: Elevation helps after removal, but continuing the infusion pushes more fluid into the tissue.
C: Flushing forces more fluid into the infiltrated tissue and does not restore placement.

Question 3

A 55-year-old female client in the intensive care unit is receiving 0.9% sodium chloride at 125 mL/hr via a peripheral intravenous line. The nurse notes swelling, coolness, and pallor around the insertion site. The client reports discomfort at the site. The IV pump shows an occlusion alarm. What is the nurse's priority action?

  1. A Remove the IV catheter and restart a new IV line in the opposite arm.
  2. B Apply a warm compress to the site and increase the infusion rate to 150 mL/hr to overcome the occlusion.
  3. C Slow the infusion rate to 50 mL/hr and reassess the site in 30 minutes for improvement.
  4. D Flush the IV line with 10 mL of normal saline to clear the occlusion and reduce swelling.
Show the answer and explanation

Correct answer: A

Swelling, coolness, pallor and discomfort at the site indicate infiltration. The nurse stops the infusion, removes the catheter, elevates the arm and restarts the IV at another site, preferably in the opposite arm.

Why the other options are wrong:
B: Increasing the rate pushes more fluid into the tissue and worsens the injury.
C: Slowing the rate still delivers fluid into the infiltrated tissue.
D: Flushing forces more fluid into the tissue and does not fix a dislodged catheter.

Question 4

A 52-year-old client on a medical-surgical unit has an intravenous infusion of 0.9% sodium chloride running at 100 mL/hr through a peripheral catheter in the left forearm. The nurse finds the client with swelling, pallor, and cool skin extending 6 cm above the catheter site. The infusion pump is alarming "occlusion." The nurse should first:

  1. A Flush the catheter with 3 mL of 0.9% sodium chloride and increase the pump rate temporarily.
  2. B Remove the intravenous catheter and apply a warm, dry compress to the swollen area.
  3. C Lower the infusion bag below the level of the heart to check for blood return.
  4. D Reposition the client’s arm and restart the infusion at the prescribed rate.
Show the answer and explanation

Correct answer: B

Swelling, pallor, and cool skin extending above the site, with an occlusion alarm, indicate infiltration: the catheter is out of the vein and fluid is entering the tissue. The nurse stops the infusion and removes the catheter, then elevates the arm and applies a compress per policy; warmth helps absorb isotonic fluid.

Why the other options are wrong:
A: Flushing or speeding the pump forces more fluid into the tissue and worsens the infiltration.
C: Checking for blood return is unreliable and delays care when the signs of infiltration are already clear.
D: Repositioning and restarting keeps infusing fluid into the tissue because the catheter is no longer in the vein.

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