SELF/Intraosseous Access/Cumulative Quiz

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Instructions

Work through each question carefully to choose the best answer, and submit the quiz to view your results. After completing the quiz, read through the answer explanations to review the reasoning behind both correct and incorrect options.

During a polytrauma resuscitation, you (as the nurse) are asked to insert IO access because peripheral veins have collapsed. You palpate the right tibia and note mild swelling and tenderness over the distal tibia. You also remember the patient has known osteoporosis. What is your best next step?

	Proceed in the right distal tibia, but document relative contraindication and watch closely for extravasation
	Decline IO access until central venous access is established given bone fragility
	Select the left proximal humerus for IO insertion and communicate to the team the rationale
	Proceed with IO insertion in the right tibia, but choose a shorter (15 mm) needle to reduce risk of fracture

A conscious adult patient in septic shock is told that an IO needle will be placed because peripheral access is failing. The patient hesitates. You say: “This lets us give life-saving fluids and medicine quickly; your arm veins are collapsing, and alternatives take too long.” Which additional statement best respects ethical duty and supports consent?

	“We will only leave it in for 48 hours; you won’t feel much once it’s placed.”
	“You can refuse; we can try cutdowns or central lines instead, though they’re slower.”
	“Let me place it now — delaying could worsen your blood pressure.”
	“It may cause pain during flushing and has small risks of infection; I’ll manage those and monitor you closely.”

You are preparing for IO insertion in a child after three failed IV attempts. Which combination of your preparation actions is most appropriate before starting the insertion?

	Don sterile gloves, open IO kit, scrub skin with antiseptic, confirm flush syringe is primed, set up pressure bag
	Don gloves and open kit, insert needle directly, then scrub around site rapidly, attach tubing
	Open IO kit first, scrub skin after selecting site, don gloves later, connect tubing at end
	Clean skin broadly, then select appropriate needle size, open kit, don gloves, then flush tubing

After you place an IO needle in the proximal humerus and begin infusion, you notice swelling and firmness around the site, infusion pressure is high, and the patient complains of increased pain. What is your best immediate action?

	Reinforce the dressing and continue, assuming minor infiltration
	Stop infusion, assess for extravasation, and remove the IO needle
	Continue infusion more slowly to reduce extravasation risk
	Send for surgical fasciotomy immediately without removing the needle

You document IO insertion in a stressed environment. Which set of elements is most critical to include to ensure safety and legal integrity?

	Patient’s full medical history, site, device brand, fluid volumes infused, consent only if signed
	Time, patient consent, full vital signs trends, nursing staff names, equipment lot numbers
	Only time, site, and that “infusion was successful”
	Time, site, needle type/size, number of attempts, aspiration success or not, complications or extravasation

In a low-resource rural clinic without commercial IO devices, you must adapt. A large-bore spinal needle is available but no pressure bag. What is the best adapted plan to maximize success and safety?

	Forego IO and proceed directly to surgical cutdown, as spinal needles are not recommended
	Use the spinal needle as IO access, apply a blood pressure cuff around the fluid bag to generate infusion pressure, and monitor closely for extravasation
	Use the spinal needle but run fluids by gravity, since pressure infusion is optional
	Use the spinal needle for IO but do not infuse until you procure a pressure bag

You plan a transition from IO to a peripheral IV once the patient’s perfusion is improving. Which integrated considerations should guide your timing and technique decision?

	Wait at least 12 hours to ensure stability, then begin IV insertion in any limb while leaving IO in place
	Leave IO in until central line is secured, then remove IO
	Remove IO only after IV is functional, choose a site contralateral to IO, and monitor for extravasation during the overlap
	Remove IO immediately once IV is attempted, regardless of success, to minimize infection risk

A comatose adult patient with no known advance directives arrives in arrest; you must insert IO. Family arrive during the procedure and ask what you're doing. What is the best approach?

	Continue under implied consent, document the emergency context, and then explain after insertion
	Pause and attempt to obtain verbal consent from the family before proceeding
	Tell the family “this is life-saving and we must do it now or he may die,” without further explanation
	Do not insert IO until a family member signs consent

You’re inserting IO in a teenager’s proximal tibia. You’re mindful of the growth plate. Which technical and safety considerations should you integrate?

	Insert 2 cm distal to tibial tuberosity on the medial surface, avoid the epiphyseal plate, and choose a needle length appropriate to limb thickness
	Insert directly at the tibial tubercle, which is safest for landmarking, even in adolescents
	Tilt the needle slightly distally to avoid injuring the growth plate, and use the longest needle to ensure marrow entry
	Use the distal femur instead, since proximal tibia is contraindicated in adolescents

During a prolonged IO infusion in a patient with limited supervision, you detect signs of early local redness and warmth around the insertion site. The patient is stable otherwise. What integrated strategy best addresses this?

	Immediately remove IO, switch to IV access even if it delays therapy, and report suspected osteomyelitis
	Slow infusion rate, monitor closely, and plan removal at 24 h
	Leave IO in until 48 h, but shield the site with extra dressings and monitor hourly
	Secure alternate IV access promptly, confirm patency, then remove the IO, inspect the site, and document the findings

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Keywords	surgery, health
SDG	SDG03 Good health and well-being
Authors	Global Surgical Training Challenge
License	CC-BY-SA-4.0
Organizations	WACS, SELF
Language	English (en)
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Redirects	WACS Training Modules/Intraosseous Access/Cumulative Quiz
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Created	October 7, 2025 by KatKor
Last edit	March 9, 2026 by Ian-laurel
Cite as	KatKor (2025–2026). "SELF/Intraosseous Access/Cumulative Quiz". Appropedia. Retrieved June 4, 2026.
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