IV Therapy for the NCLEX: Fluids, Complications and Nursing Care

Types of IV fluids

Tonicity decides where the fluid goes:

• Isotonic (0.9% NaCl, lactated Ringer's, D5W in the bag): stays in the vessels, used for hypovolemia, blood loss and surgery. Watch for fluid overload. Avoid lactated Ringer's in severe liver disease or lactic acidosis.
• Hypotonic (0.45% NaCl): moves into cells, used for hypernatremia and cellular dehydration. Avoid in increased intracranial pressure, burns and trauma, because it can worsen swelling and low blood volume.
• Hypertonic (3% NaCl, D10W): pulls fluid from cells into vessels, used for severe hyponatremia and cerebral edema. Give slowly through a pump and check sodium often.
• D5W acts isotonic in the bag but becomes hypotonic once the glucose is used, so it is not a volume expander.

IV complications and what to do

• Infiltration — swelling, coolness, pallor, slowed flow. Stop the infusion, remove the catheter, elevate the limb, restart at another site.
• Extravasation (vesicant leak) — stop, follow the facility's antidote protocol before removing the catheter if required, notify the provider.
• Phlebitis — redness, warmth, a tender cord along the vein. Stop, remove, apply a warm compress, restart in the other arm.
• Fluid overload — crackles, dyspnea, distended neck veins, rising BP. Slow or stop the infusion, raise the head of the bed, give oxygen, notify the provider.
• Air embolism — sudden dyspnea, chest pain, hypotension. Clamp the line, place the client on the left side with the head down (Trendelenburg), give oxygen, call for help.
• Local or systemic infection — fever, drainage at the site. Remove the line, culture as ordered, notify the provider.

IV potassium safety

• Never give potassium by IV push or bolus.
• Always dilute it and run it through an infusion pump at the prescribed rate (commonly no faster than 10 mEq/hr on a general unit).
• Check that urine output is adequate before and during the infusion.
• Expect burning at the site; stop and assess if it occurs.
• Use cardiac monitoring for higher rates according to policy.

Blood transfusion basics

Use 0.9% saline only with blood products. Two licensed nurses verify the client and the product. Stay with the client for the first 15 minutes, when most acute reactions occur. If you see fever, chills, back pain, itching, wheezing or low blood pressure, stop the transfusion, keep the line open with saline through new tubing, and notify the provider and the blood bank.

IV calculation quick reference

• mL/hr = total volume (mL) ÷ time (hr).
• gtt/min = (volume in mL × drop factor) ÷ time in minutes.
• Example: 1,000 mL over 8 hours = 125 mL/hr.

Practice questions with rationales

Original NCLEX-style questions. Choose an answer to see the rationale.

Frequently asked questions