Chapter 23: Specimen Collection and Diagnostic Testing

1. New physician orders are transcribed for a patient to receive a colonoscopy. What must be completed before the colonoscopy to indicate the patient has been given full knowledge about what will be done along with its risks and complications?

a. Patients' rights

b. Advance directive

c. Informed consent

d. Patient protection

ANS: C

Informed consent states that the patient must fully understand and be aware of the risks and complications of what is to be done.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 366, 373 Table 15-1 OBJ: 1 TOP: Proper preparation

KEY: Nursing Process Step: Planning

2. The nurse is preparing a patient for a diagnostic examination. What can the nurse implement to assist with reducing anxiety?

a. Explain the costs of the examination

b. Demonstrate use of equipment

c. Answer questions for clarification

d. Fill out required paperwork

ANS: C

The nurse must be prepared to answer questions that the patient may have to reduce anxiety and give valid information.

PTS: 1 DIF: Cognitive Level: Application REF: Page 366 OBJ: 2 TOP: Proper preparation

KEY: Nursing Process Step: Implementation

3. A patient is required to provide a sample of body excretions per physician order. What action can the nurse take when providing proper instructions to lessen the patient's embarrassment?

a. Instruct patient to provide the specimen behind a screen.

b. Instruct patient to obtain his or her own specimen.

c. Instruct patient to return later when he or she is more comfortable.

d. Instruct patient to use a CNA for assistance to obtain the specimen.

ANS: B

With proper instruction, many patients may obtain their own specimen.

PTS: 1 DIF: Cognitive Level: Application REF: Page 383 OBJ: 3 TOP: Specimen collection

KEY: Nursing Process Step: Implementation

4. What health care professional has the responsibility for notifying the physician when laboratory and diagnostic studies deviate from the norm?

a. Laboratory technician

b. Cooperating physician

c. Nurse

d. Supervisor

ANS: C

It is the nurse's responsibility to notify the physician when laboratory and diagnostic studies deviate from the norm.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 383 OBJ: 4 TOP: Diagnostic studies

KEY: Nursing Process Step: Assessment

5. What is the term for the cleanest part of a voided urine specimen that is collected after voiding is initiated and before it is finished?

a. Sterile specimen

b. "Caught" specimen

c. Midstream specimen

d. Patient-collected specimen

ANS: C

A midstream urine specimen is collected after voiding is initiated and before it is completed.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 385

OBJ: 5 | 6 TOP: Specimen KEY: Nursing Process Step: Implementation

6. The patient is to be catheterized for residual urine. The nurse must perform this catheterization within how many minutes following voiding?

a. 40 minutes

b. 30 minutes

c. 20 minutes

d. 10 minutes

ANS: D

Catheterization is performed within 10 minutes of the patient voiding to check for residual urine.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 385

OBJ: 8 TOP: Specimen KEY: Nursing Process Step: Implementation

7. The process for collecting a blood specimen for measuring blood glucose levels begins by asking the patient to hold the selected arm at his or her side for 30 seconds. From what anatomic location is the specimen obtained?

a. Tip of the finger

b. Cubital fossa

c. Side of the finger

d. Center of the thumb

ANS: C

The specimen should be collected from the side of the selected finger to avoid painful fingertip sticks.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 389, Skill 15-5 OBJ: 9 TOP: Specimen KEY: Nursing Process Step: Implementation

8. What type of stool specimen must be sent to the laboratory immediately?

a. Occult blood

b. Ova and parasites

c. Infection

d. Fats

ANS: B

A stool specimen for the presence of ova or parasites must be taken to the laboratory immediately.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 391, Skill 15-6 OBJ: 10 TOP: Specimen KEY: Nursing Process Step: Implementation

9. What is the probable source of bright red blood in the stool?

a. Stomach

b. Small intestine

c. Lower gastrointestinal tract

d. Higher intestinal tract

ANS: C

When blood in the stool is bright red, the site of bleeding is most likely from the lower gastrointestinal tract.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 390 OBJ: 4 | 10 TOP: Specimen KEY: Nursing Process Step: Assessment

10. A sputum specimen is ordered on a patient diagnosed with pneumonia. When is the best time for the nurse to the attempt to collect this specimen?

a. At bedtime

b. After lunch

c. In the early morning

d. After breakfast

ANS: C

Early morning before a meal is the best time to collect a sputum specimen.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Pages 390

OBJ: 11 TOP: Specimen KEY: Nursing Process Step: Implementation

11. A patient is unable to obtain a sputum specimen by coughing and expectorating. What is the best way for the nurse to collect this specimen?

a. Ask the patient to spit

b. Direct the patient to turn, cough, and breathe deeply

c. Perform tracheal suctioning

d. Perform a bronchoscopy

ANS: C

Some patients cannot expectorate and must have the trachea suctioned to obtain a specimen.

PTS: 1 DIF: Cognitive Level: Application REF: Page 390

OBJ: 11 TOP: Specimen KEY: Nursing Process Step: Implementation

12. The nurse is collecting a specimen for a wound culture. What should be avoided when collecting this specimen?

a. A dressing

b. Deep in the wound

c. The outer edge of the wound

d. Old drainage

ANS: D

The nurse should not collect a wound culture from old drainage.

PTS: 1 DIF: Cognitive Level: Application REF: Page 395

OBJ: 5 TOP: Specimen KEY: Nursing Process Step: Implementation

13. Anaerobic organisms tend to grow within body cavities. What will the nurse use to collect an anaerobic specimen?

a. Sterile cotton applicator

b. Sterile culture tube

c. Sterile syringe tip

d. Sterile glass rod

ANS: C

To collect an anaerobic specimen deep in a body cavity, the nurse uses a sterile syringe tip.

PTS: 1 DIF: Cognitive Level: Application REF: Page 395

OBJ: 5 TOP: Specimen KEY: Nursing Process Step: Implementation

14. The nurse is obtaining a throat culture. What area will the nurse swab with a cotton-tipped applicator?

a. Larynx

b. Oral mucosa

c. Pharynx

d. Trachea

ANS: C

The nurse should swab the tonsillar area (pharynx) with a sterile cotton-tipped applicator to obtain a specimen for a throat culture.

PTS: 1 DIF: Cognitive Level: Application REF: Page 398, Skill 15-11 OBJ: 4 TOP: Specimen KEY: Nursing Process Step: Implementation

15. The nurse explains that electrocardiograms are graphic representations of electrical impulses generated by the heart. What type of abnormalities can an electrocardiogram identify?

a. Those that produce a cardiac cycle

b. Those that interfere with electrical conduction

c. Those that result from an interrupted blood flow

d. Those that interfere with heart contraction

ANS: B

Electrocardiograms identify abnormalities that interfere with electrical conduction.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 402 OBJ: 13 TOP: Electrocardiogram

KEY: Nursing Process Step: Implementation

16. What is the rationale for the nurse to assess a patient's knowledge of an ordered procedure?

a. To determine difficulties the patient may encounter

b. To determine the nurse's role in the procedure

c. To determine health teaching required

d. To determine anxiety the patient has

ANS: C

The nurse will need to assess the patient's knowledge of the procedure to determine the level of health care teaching needed.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 368, Box 15-1 OBJ: 2 TOP: Teaching needs

KEY: Nursing Process Step: Assessment

17. What should the nurse assess the patient for before administration of contrast media?

a. Has been NPO

b. Is allergic to iodine

c. Has emptied the bladder

d. Has taken medication

ANS: B

The patient should always be assessed for allergies to iodine before administration of contrast media.

PTS: 1 DIF: Cognitive Level: Application REF: Page 368, Box 15-2 OBJ: 2 TOP: Diagnostic examination

KEY: Nursing Process Step: Assessment

18. The nurse should administer Telepaque in preparation for a cholecystogram. How frequently will the nurse administer one tablet of Telepaque before this procedure?

a. Every 5 minutes

b. Every 10 minutes

c. Every 15 minutes

d. Every 20 minutes

ANS: C

Telepaque should be taken one at a time, waiting 15 minutes after each tablet.

PTS: 1 DIF: Cognitive Level: Application REF: Page 376, Table 15-1 OBJ: 2 TOP: Diagnostic examination

KEY: Nursing Process Step: Implementation

19. Following a liver biopsy, the nurse should observe for hemorrhage and ensure that the patient is kept on bed rest for 24 hours. How should the nurse keep the patient for the first 1 to 2 hours?

a. On his or her left side

b. On his or her back

c. On his or her right side

d. In high Fowler position

ANS: C

The nurse should keep the patient on his or her right side for 1 to 2 hours.

PTS: 1 DIF: Cognitive Level: Application REF: Page 378, Table 15-1 OBJ: 1 | 2 TOP: Diagnostic examination

KEY: Nursing Process Step: Implementation

20. The patient has undergone a lumbar puncture. What position will the nurse place the patient in for up to 12 hours to avoid discomfort from postpuncture spinal headache?

a. Supine

b. Lateral

c. Sims

d. Prone

ANS: D

The nurse should place the patient in the prone position and keep in reclining position for 12 hours.

PTS: 1 DIF: Cognitive Level: Application REF: Page 478, Table 15-1 OBJ: 1 | 2 TOP: Diagnostic examination

KEY: Nursing Process Step: Implementation

21. The procedure for collecting a sterile urine specimen via a catheter port includes clamping the Foley catheter tubing below the catheter port. How long will the clamp remain in place?

a. 5 minutes

b. 10 minutes

c. 20 minutes

d. 30 minutes

ANS: D

Clamp just below the catheter port for 30 minutes.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 487, Skill 15-3 OBJ: 1 TOP: Specimen KEY: Nursing Process Step: Implementation

22. The nurse is caring for a patient following a bronchoscopy and maintains NPO status for 2 hours. What additional assessment will indicate to the nurse that this patient's risk for aspiration has decreased?

a. Patient is fully awake

b. Patient asks for a drink

c. Gag reflex has returned

d. Preoperative medication has worn off

ANS: C

The nurse should not allow the patient to eat or drink after a bronchoscopy until the gag reflex has returned.

PTS: 1 DIF: Cognitive Level: Application REF: Page 372, Table 15-1 OBJ: 1 TOP: Diagnostic examination

KEY: Nursing Process Step: Implementation

23. The nurse has an order to perform occult blood testing on a patient's emesis. What color will the sample turn to indicate that the test is positive for occult blood?

a. Red

b. Blue

c. Green

d. Yellow

ANS: B

If the sample turns blue, the test is positive for occult blood; if it turns green, it is negative for occult blood.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 393, Skill 15-8 OBJ: 1 TOP: Occult blood testing

KEY: Nursing Process Step: Implementation

24. What should the nurse do when preparing the patient for an abdominal scan?

a. Assess laboratory results only for liver function

b. Assess patient for allergies to dye or shellfish

c. Instruct patient to limit fluid intake immediately following procedure

d. Instruct patient to be NPO for 1 hour before scan if contrast medium is used

ANS: B

The patient should be assessed for allergies to dye or shellfish. When a patient has an abdominal scan, laboratory results should be assessed for kidney function. The patient should be instructed to be NPO for 4 hours before the examination if contrast medium is to be used. The patient should be encouraged to consume fluids after the examination.

PTS: 1 DIF: Cognitive Level: Application REF: Page 369, Table 15-1 OBJ: 1 | 2 TOP: Diagnostic examination

KEY: Nursing Process Step: Implementation

25. What should the nurse do when preparing the patient for an arteriography?

a. Verify if the patient has been taking anticoagulants

b. Keep the patient NPO for 24 hours before the procedure

c. Instruct the patient to have a full bladder for the procedure

d. Inform the patient that a coldness may be felt when dye is injected

ANS: A

When a patient has an arteriography, the nurse should assess if the patient has been taking anticoagulants. The patient is kept NPO for 2 to 8 hours before the procedure. The nurse informs the patient that a warm flush may be felt when dye is injected. The patient is instructed to void before the arteriography.

PTS: 1 DIF: Cognitive Level: Application REF: Page 369, Table 15-1 OBJ: 1 | 2 TOP: Diagnostic examination

KEY: Nursing Process Step: Implementation

26. The nurse is preparing a patient for a barium enema. What color will the nurse inform the patient his stools will be following this procedure?

a. Blue

b. White

c. Green

d. Brown

ANS: B

Immediately following a barium enema, a patient's stools are white until all of the barium is expelled.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 370, Table 15-1 OBJ: 2 | 3 TOP: Diagnostic examination

KEY: Nursing Process Step: Implementation

27. What should the nurse do when preparing the patient for an amniocentesis?

a. Restrict food intake

b. Restrict fluid intake

c. Monitor fetal heart tones

d. Inform patient results will be available immediately

ANS: C

When a patient has an amniocentesis, fetal heart tones should be monitored. There are no fluid or food restrictions, and the patient should be told to contact her physician to obtain results, which are usually available after 2 weeks.

PTS: 1 DIF: Cognitive Level: Application REF: Page 369, Table 15-1 OBJ: 2 TOP: Diagnostic examination

KEY: Nursing Process Step: Implementation

28. What should the nurse do when preparing the patient for a bone scan?

a. Sedate the patient

b. Restrict food intake

c. Restrict fluid intake

d. Encourage water intake

ANS: D

Before a bone scan, the patient is encouraged to drink several glasses of water. No fasting or sedation is required before a bone scan.

PTS: 1 DIF: Cognitive Level: Application REF: Page 371, Table 15-1 OBJ: 2 TOP: Diagnostic examination

KEY: Nursing Process Step: Implementation

29. What should the nurse do when preparing the patient for a brain scan?

a. Allow the patient to wear a wig during the scan

b. Allow the patient to wear a partial denture plate during the scan

c. Inform the patient that a clicking noise will be heard during the scan

d. Keep the patient NPO for 12 hours before scan if contrast dye is used

ANS: C

Before a brain scan, the patient is kept NPO for 4 hours if contrast dye is to be used, the patient is instructed not to wear a wig, hairpins, clips, or partial denture plates, and the nurse informs the patient that a clicking noise is made as the scanner moves.

PTS: 1 DIF: Cognitive Level: Application REF: Page 371, Table 15-1 OBJ: 2 TOP: Diagnostic examination

KEY: Nursing Process Step: Implementation

30. What should the nurse do when preparing the patient for a bronchoscopy?

a. Instruct the patient to hold his or her breath during the procedure

b. Instruct the patient to remain NPO 24 hours before the procedure

c. Obtain informed consent after premedicating the patient

d. Reassure the patient that he or she will be able to breathe during the procedure

ANS: D

The nurse should reassure a patient before a bronchoscopy that they will be able to breathe during the procedure. The patient is instructed to remain NPO after midnight (4 to 8 hours) before the procedure. Informed consent must be obtained before the patient is premedicated.

PTS: 1 DIF: Cognitive Level: Application REF: Page 372, Table 15-1 OBJ: 2 TOP: Diagnostic examination

KEY: Nursing Process Step: Implementation

31. What should the nurse encourage the patient to consume when preparing for an electroencephalogram (EEG)?

a. Tea

b. Food

c. Cola

d. Coffee

ANS: B

Food intake should be encouraged, but coffee, tea, and colas should be eliminated before an EEG.

PTS: 1 DIF: Cognitive Level: Application REF: Page 374, Table 15-1 OBJ: 2 TOP: Diagnostic examination

KEY: Nursing Process Step: Implementation

32. What intervention should the nurse implement when preparing the patient for a glucose tolerance test (GTT)?

a. Restrict water intake before the test

b. Encourage water intake before the test

c. Keep patient NPO 4 hours before the test

d. Instruct patient to have a full bladder for the test

ANS: B

A patient having a glucose tolerance test should be kept NPO for 12 hours before the test except for water consumption so that they can provide urine samples. The patient should empty their bladder before the examination.

PTS: 1 DIF: Cognitive Level: Application REF: Page 376, Table 15-1 OBJ: 2 TOP: Diagnostic examination

KEY: Nursing Process Step: Implementation

33. What should the nurse do when preparing the patient for an exercise tolerance test (treadmill)?

a. Withhold all foods and fluids before the test

b. Withhold all heart medications before the test

c. Allow the patient to drink water before the test

d. Allow the patient to consume food before the test

ANS: C

A patient having an exercise tolerance test is kept NPO, except for water, for 4 hours until after the test. The nurse should never withhold the patient's heart medications before this test.

PTS: 1 DIF: Cognitive Level: Application REF: Page 375, Table 15-1 OBJ: 2 TOP: Diagnostic examination

KEY: Nursing Process Step: Implementation

34. A patient has just had a liver biopsy. What should the nurse do immediately following this procedure?

a. Assist the patient up to a chair

b. Keep the patient on his or her left side

c. Assist the patient with ambulation

d. Tell the patient to avoid coughing

ANS: D

The nurse should tell the patient to avoid coughing or straining, which may cause increased intra-abdominal pressure. Immediately following a liver biopsy, the patient is kept on bed rest for 24 hours. The patient should lie on his or her right side for about 1 to 2 hours.

PTS: 1 DIF: Cognitive Level: Application REF: Page 378, Table 15-1 OBJ: 1 TOP: Diagnostic examination

KEY: Nursing Process Step: Implementation

35. The nurse is preparing to collect a urine specimen. What will this nurse include when labeling this specimen? (Select all that apply.)

a. Date and time of collection

b. Identification of last name only

c. Room number

d. Medical record number

e. Insurance information

ANS: A, C, D

When labeling a specimen date and time of collection, room number and medical record number should be included. Patient should be identified by full name. Insurance information is not necessarily included.

PTS: 1 DIF: Cognitive Level: Application REF: Page 390, Box 15-5 OBJ: 7 TOP: Labeling specimens

KEY: Nursing Process Step: Implementation

36. After a bone scan, the nurse assesses a hematoma at the injection site of the dye. The nurse should apply soaks or compresses.

ANS:

warm

Heat will speed absorption of collected blood.

PTS: 1 DIF: Cognitive Level: Application REF: Page 371, Table 15-1 OBJ: 1 TOP: Hematoma at injection site

KEY: Nursing Process Step: Implementation

37. When initiating a 24-hour urine collection, the nurse asks the patient to void. The nurse then

the specimen.

ANS:

discards

The first voided specimen of a 24-hour collection is discarded.

PTS: 1 DIF: Cognitive Level: Application REF: Page 388, Skill 15-4 OBJ: 4 | 8 TOP: 24-hour urine specimen

KEY: Nursing Process Step: Implementation

38. Following an intravenous pyelogram, the nurse should watch the patient closely for a delayed reaction to the dye, usually occurring within to hours following the procedure.

ANS:

2, 6

two, six

Delayed reactions to iodine may not be obvious until 2 to 6 hours postprocedure.

PTS: 1 DIF: Cognitive Level: Application REF: Page 368, Box 15-2 OBJ: 1 TOP: Iodine allergy

KEY: Nursing Process Step: Assessment

39. When collecting a stool specimen for a guaiac (occult blood in stool), the nurse should take a specimen from different parts of the stool.

ANS:

2

two

The selection of different parts of the stool gives a broader testing range of the specimen.

PTS: 1 DIF: Cognitive Level: Application REF: Page 392, Skill 15-7 OBJ: 10 TOP: Occult blood specimen

KEY: Nursing Process Step: Implementation

40. When performing a venipuncture, the tourniquet should be left on no more than to minutes.

ANS:

1, 2

one, two

Occluding the vein for longer than 1 or 2 minutes may cause damage to the vein or cause it to rupture.

PTS: 1 DIF: Cognitive Level: Application REF: Page 405, Skill 15-13 OBJ: 12 TOP: Venipuncture

KEY: Nursing Process Step: Implementation