CH 24 Diagnostic Tests and Specimen Collection

A patient who is on an anticoagulant (Coumadin) asks,"What did the primary care provider mean when he said I was to have my blood tested every 2 weeks?"

The nurse explains, "It is important to monitor the effects of the drug to see how long it takes your blood to clot.

The blood test the primary care provider was talking about is the:

1. complete blood count (CBC)."

2. activated partial thromboplastin time (APTT)."

3. international normalized ratio (INR)."

4. erythrocyte sedimentation rate (ESR)."

ANS: C

The INR is a method for reporting the prothrombin time, which is prolonged with warfarin (Coumadin) therapy.

DIF: Cognitive Level: Knowledge

REF: p. 410

TOP: Blood Tests KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

OBJ: Theory #2

A patient is scheduled to have a blood chemistry profile drawn at 8 AM tomorrow. The note should be added on the care plan and report provided to the oncoming shift to withhold food and drink after:

1. 6 AM.

2. 12 midnight tonight.

3. 4 AM today.

4. noon today.

ANS: B

Food and drink are usually withheld for 8 to 12 hours before blood chemistry tests are performed.

DIF: Cognitive Level: Application

REF: p. 411

TOP: Blood Tests KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care

OBJ: Theory #3

A patient wants to know what was meant when the doctor said that his white blood cell

(WBC) count had a shift to the left. The nurse explains that a shift to the left indicates:

1. an improvement in an infectious process.

2. the relative effectiveness of the antibiotic therapy.

3. an increase in the number of immature WBCs.

4. that the infection is viral in nature.

ANS: C

In reporting a differential WBC, the less mature WBCs are reported on the left side of the page. An increase in immature WBCs causes the left side of the report to show large numbers and indicates an infection.

DIF: Cognitive Level: Comprehension

REF: p. 410

OBJ: Clinical Practice #1

TOP: Differential KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

The nurse instructing in the collection of a midstream urine catch would tell the patient to first cleanse the external genitalia and then to:

1. begin voiding into the specimen cup.

2. let a few drops of urine dribble into the specimen cup.

3. void until the bladder is almost empty and then collect the end portion of the voiding in the cup.

4. pass a small amount of urine into the toilet and then collect the specimen.

ANS: D

To collect a midstream specimen, the external genitalia are cleansed, a small amount of urine is passed, and then a midportion of the voiding is collected in a sterile container and used for a culture.

DIF: Cognitive Level: Application

REF: p. 411

OBJ: Clinical Practice #1

TOP: Urinalysis

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

The nurse instructs an outpatient female patient preparing for an abdominal ultrasonography that prior to the procedure, she should:

1. eat or drink nothing after midnight.

2. drink a liter of water.

3. empty the bladder fully.

4. use enemas at home to clear the bowel fully.

ANS: B

For abdominal ultrasonography, the patient is asked to drink a liter of water before the procedure. This helps change the echo reflection pattern from the bladder, helping to better distinguish the bladder from the female reproductive organs that lie nearby.

DIF: Cognitive Level: Application

REF: p. 416

OBJ: Clinical Practice #1

TOP: Abdominal Ultrasonography

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

The nurse preparing a patient for a magnetic resonance imaging (MRI) should determine if the patient has:

1. respiratory allergies.

2. claustrophobia.

3. fear of the dark.

4. dizziness.

ANS: B

The patient with claustrophobia can be reassured that there are methods to contact persons outside the cylinder.

DIF: Cognitive Level: Application

REF: p. 422

TOP: Fluoroscopy KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

Prior to the nurse transporting the patient to have a magnetic resonance imaging (MRI), it is essential that the nurse confirms that the patient:

1. has eaten a meal.

2. has drunk a liter of fluid.

3. is not wearing anything with metal.

4. has a Foley catheter in place.

ANS: C

Nursing care before an MRI involves obtaining consent and ensuring that all metal is removed from the patient's body, because the machine emits a strong magnetic field

DIF: Cognitive Level: Application

REF: p. 422

OBJ: Clinical Practice #4

TOP: MRI

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

A patient who is scheduled for a cardiac catheterization asks what the catheterization will reveal that an electrocardiogram would not. The nurse explains that the catheterization shows:

1. the entire heart to find evidence of cancer.

2. heart rhythm.

3. electrical activity of the heart action.

4. oxygen concentration at various sites.

ANS: D

Cardiac catheterization is a procedure that determines the function of the heart, valves, and coronary circulation with its attendant oxygen concentration.

DIF: Cognitive Level: Comprehension REF: p. 422

OBJ: Clinical Practice #1

TOP: Catheterization

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

A patient who is to have a treadmill stress test at 11:00 AM today should not consume:

1. toast and jam.

2. coffee and cream.

3. oatmeal and sugar.

4. pancakes and syrup.

ANS: B

The patient should avoid caffeine and smoking for 6 hours before the test, but may have a light meal 2 or more hours beforehand.

DIF: Cognitive Level: Comprehension REF: p. 425

TOP: Treadmill

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

OBJ: Clinical Practice #1

A patient who has undergone endoscopy is fully awake and asks the nurse for something to drink. After confirming that liquids are allowed on the primary care provider order sheet, the nurse should:

1. assist the patient to the bathroom to void.

2. listen to lung sounds.

3. take a blood pressure and pulse.

4. check for the return of gag and swallow reflexes.

ANS: D

The patient should take nothing by mouth until the effects of local anesthesia have worn off and airway protective reflexes (such as gag and swallow reflexes) have returned.

DIF: Cognitive Level: Analysis

REF: p. 427

OBJ: Clinical Practice #1

TOP: Endoscopic Examinations

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

The patient in the skilled nursing facility who is to have a colonoscopy tomorrow complains about his limited diet prior to the examination. The nurse may offer the patient:

1. lime Jell O.

2. strawberry soda.

3. oatmeal thinned with milk.

4. vanilla ice cream.

ANS: A

The patient is placed on a clear liquid diet for 24 hours before colonoscopy and should avoid liquids that contain red or purple dye. Jell O is part of a clear liquid diet.

DIF: Cognitive Level: Application

REF: p. 426

OBJ: Clinical Practice #1

TOP: Endoscopic Examinations

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

A patient has undergone cystoscopy and has a Foley catheter in place on return to the nursing unit. Immediately after the procedure, the nurse expects the urine color to be:

1. clear as water.

2. bright red with clots.

3. pink tinged.

4. cherry colored.

ANS: C

It is common for the urine to be pink tinged after cystoscopy, but red bleeding and clots should be reported to the primary care provider.

DIF: Cognitive Level: Comprehension

REF: p. 427

TOP: Cystoscopy KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

OBJ: Clinical Practice #1

A patient will undergo endoscopic retrograde cholangiopancreatography (ERCP) to determine the cause of jaundice. Before the test, the nurse would assess this patient for an allergy to:

1. eggs.

2. pork.

3. aspirin.

4. shellfish

ANS: D

Allergy to shellfish is assessed, because an iodine-based contrast medium is used during the test. Shellfish hold and store iodine.

DIF: Cognitive Level: Application

REF: p. 427

OBJ: Clinical Practice #1

TOP: Endoscopic Examinations

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

For the patient who just had a liver biopsy performed, the nurse should position him:

1. prone for 1 hour.

2. on his right side lying for 2 hours.

3. supine for 3 hours.

4. on his left side lying for 4 hours.

ANS: B

The patient should be turned onto the right side for 2 hours after the procedure to minimize bleeding from the site.

DIF: Cognitive Level: Comprehension REF: p. 425|Table 24-5

OBJ: Clinical Practice #5

TOP: Liver Biopsy

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

Following a colonoscopy with polyp removal, the wife of the patient is distressed that there is slight bleeding from her husband's rectum. The nurse's most helpful response would be:

1. "This small amount of bleeding is expected after the removal of polyps."

2. "I will notify the primary care provider about this hemorrhage."

3. "I will watch your husband very carefully to assess any further hemorrhage."

4. "Don't worry. This small amount of blood happens with these procedures."

ANS: A

A small amount of bleeding following a colonoscopy with polyp removal is to be expected.

The family should be prepared for the slight bleeding.

DIF: Cognitive Level: Application

REF: p. 426

OBJ: Clinical Practice #1

TOP: Colonoscopy

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

To improve the comfort of an older adult patient who is to be in the radiology department for several hours, the nurse should send a(n):

1. family member with the patient.

2. extra pillow.

3. blanket.

4. newspaper to read.

ANS: C

Older adults may become chilled by the cooler temperatures commonly experienced in ancillary departments such as radiology.

DIF: Cognitive Level: Application

REF: p. 439

TOP: Elder Care KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

OBJ: Theory #4

An older adult patient has had a series of enemas in preparation for a gastrointestinal diagnostic procedure. Which electrolytes should be monitored following the enemas?

1. Calcium and chloride

2. Sodium and potassium

3. Magnesium and phosphorus

4. Selenium and zinc

ANS: B

A series of enemas can upset electrolyte balance, especially potassium and sodium.

DIF: Cognitive Level: Application

REF: p. 427

OBJ: Theory #4

TOP: Loss of Electrolytes

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

The nurse explains to the patient that the significance of the hematocrit is that it:

1. indicates the number of circulating white blood cells.

2. indicates the value of the hemoglobin.

3. refers to the separation of blood cells from plasma.

4. will decrease when the patient is in shock

ANS: C

The hematocrit refers to the relationship of blood cells to plasma in the circulating volume.

DIF: Cognitive Level: Knowledge

REF: p. 409

OBJ: Theory #2

TOP: Hematocrit KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

When obtaining a capillary blood sample for blood glucose, the nurse will select the puncture site to cause the least amount of discomfort, which is:

1. the end of the index finger.

2. the ball of the third finger.

3. at right angles to the fingerprint lines.

4. the ball of the thumb.

ANS: C

Using the right angle to the fingerprint lines places the puncture on the side of the finger rather than on more sensitive areas.

DIF: Cognitive Level: Application

REF: p. 414|Skill 24-2

OBJ: Theory #3 TOP: Capillary Blood Test

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

A patient asks why the blood glucose meter directions state to wipe away the first drop of blood. The most informative response by the nurse would be:

1. "This eliminates microorganisms from the sample."

2. "The first drop is usually too small."

3. "The first drop is usually contaminated."

4. "The first drop has serous fluid that can dilute the specimen."

ANS: D

Some machines state to wipe away the first drop of blood, which often contains a large portion of serous fluid that can dilute the specimen, causing a false result.

DIF: Cognitive Level: Comprehension REF: p. 414|Skill 24-2

OBJ: Theory #3

TOP: Blood Glucose Testing

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

A patient in the outpatient clinic has provided a urine sample. To perform a urine dipstick test accurately, the nurse wets the dipstick and starts timing:

1. immediately.

2. after 5 seconds.

3. after 10 seconds.

4. after 30 seconds.

ANS: A

The stick is inserted into the urine specimen and removed quickly, and timing is started immediately. It is tapped gently on the side of the container to remove excess urine.

DIF: Cognitive Level: Knowledge

REF: p. 411

OBJ: Theory #3

TOP: Urine Dipstick Test

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

The nurse obtaining a wound culture would:

1. use clean gloves.

2. rotate the swab vigorously in the wound bed.

3. rinse the exudate on the swab with normal saline.

4. place the swab in the culture tube without touching the sides.

ANS: D

The nurse should use sterile gloves, rotate the swab gently in the wound bed, and place it directly into the culture tube without touching the sides of the tube.

DIF: Cognitive Level: Knowledge

REF: p. 422

OBJ: Theory #3

TOP: Wound Culture

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

The patient who has just returned to the unit after an angiography test should be assessed immediately for:

1. swelling of tongue.

2. pulmonary congestion.

3. bleeding at insertion site.

4. hypotension.

ANS: C

The insertion site is monitored for bleeding or formation of a hematoma.

DIF: Cognitive Level: Application

REF: pp. 422-423 OBJ: Clinical Practice #1

TOP: Angiography

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

The nurse instructing a patient who is to have a Papanicolaou smear (Pap smear) in 2 days would tell the patient to avoid:

1. sexual intercourse.

2. douching.

3. eating shellfish.

4. taking a bubble bath.

ANS: B

The patient who is to have a Pap smear should avoid douching or using any vaginal medication that might interfere with the collection of the cells of the cervix.

DIF: Cognitive Level: Application

OBJ: Clinical Practice #7

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment

REF: p. 432|Skill 24-6

TOP: Pelvic Examination

The statement made by a patient that would delay a scheduled CT scan would be:

1. "I have terrible claustrophobia."

2. "I have just been started on metformin."

3. "I am allergic to penicillin."

4. "I have an implanted pacemaker."

ANS: B

Metformin should be discontinued before the test with an iodine-based contrast medium because metformin significantly alters renal function.

DIF: Cognitive Level: Analysis

REF: p. 421

OBJ: Theory #1

TOP: Metformin

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapy

The nurse evaluates a prothrombin time (PT/INR) for a patient who is taking heparin. The nurse's initial action should be to:

1. document the findings in the medical record.

2. notify the laboratory that they have made an error.

3. check the primary care provider's order.

4. notify the primary care provider of the laboratory finding

ANS: C

Check the primary care provider's orders to determine what test was ordered. If the PT/INR was ordered, confer with the charge nurse or primary care provider as to the intent. The PT/INR measures the effectiveness of the drug warfarin (Coumadin), not heparin. A partial thromboplastin is the test used to evaluate the effectiveness of heparin.

DIF: Cognitive Level: Analysis

REF: p. 410

OBJ: Theory H2

TOP: Partial Thromboplastin

KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

A major concern for an 86-year-old patient who has been NPO for 8 hours prior to a diagnostic test would be:

1. fatigue.

2. circulatory status.

3. hydration status.

4. nutritional status.

ANS: C

An older adult who is kept on an NPO status for prolonged periods of time are susceptible to dehydration and electrolyte imbalances.

DIF: Cognitive Level: Comprehension REF: p. 427

OBJ: Theory #4

TOP: Dehydration in the Older Adult KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

A patient is having an MRI for a knee injury. During the test, he complains of burning in his upper thigh and swelling. Which of the following is the most probable cause of this complaint?

1. Fluid is trapped in the leg due to the dependent positioning.

2. Discomfort most likely related to injury in the knee.

3. Trace metals in ink from a tattoo on the thigh.

4. Discomfort indicates an emergency and requires discontinuation of the MRI.

ANS: C

Patients with tattoos occasionally report burning or swelling of the tattooed area as some inks contain traces of metal. The patient must inform the MRI technician of any tattoos, and if they experience any burning feeling during the procedure.

DIF: Cognitive Level: Analysis

REF: p. 422

TOP: MRI

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

OBJ: Clinical #8

The nurse is aware that the medical record of a patient going for a cardiac catheterization should have: (Select all that apply.)

1. a signed consent form.

2. a complete history and physical examination.

3. evidence of the initiation of NPO status at least 2 hours prior.

4. evidence of patient education done before the consent form is signed.

5. report of kidney function tests.

6. administration of ordered preoperative medications.

ANS: A, B, D, F

Patient education must be done before a signed consent form is initiated. A complete history and physical examination is done and NPO status is initiated at least 6 hours prior to the procedure. The patient is also given ordered preoperative medications.

DIF: Cognitive Level: Application

REF: p. 422

OBJ: Clinical Practice #1

TOP: Informed Consent

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

The primary care provider has ordered the collection of a 24-hour urine specimen. The nurse's instructions to the patient for proper collection of the urine specimen include: (Select all that apply.)

1. keep the container refrigerated as needed.

2. empty the bladder into the toilet and begin timing the collection.

3. void a small amount of urine after external genitalia are cleansed.

4. keep the container on ice if instructed to do so.

5. save only the first voiding in the morning.

ANS: A, B, D

When a 24-hour urine specimen is collected, the patient should be instructed to empty the bladder into the toilet and begin timing the collection of the specimen; to add all urine to the collection container for the next 24 hours; to keep the container on ice or refrigerated; and when the 24 hours are up, to empty the bladder and add the urine to the collection container and then seal it and send it to the laboratory.

DIF: Cognitive Level: Application

REF: p. 411

OBJ: Clinical Practice #1

TOP: Health Education

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

The nurse is aware that patients who are not candidates for magnetic resonance imaging

(MRI) include patients with: (Select all that apply.)

1. a hip prosthesis.

2. bleeding tendencies.

3. allergy to iodine.

4. cardiac pacemakers.

5. previous radiological treatment.

ANS: A, D

Patients with prosthetic hips and knees, implanted pacemakers, or metal clips or staples are not candidates for an MRI because of the magnetic field the test creates.

DIF: Cognitive Level: Comprehension REF: p. 417

OBJ: Clinical Practice #4

TOP: MRI

KEY: Nursing Process Step: Planning

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

The nurse informs the patient who is to have an electroencephalogram (EEG) that the technician will try to stimulate seizure activity by asking the patient to: (Select all that apply.)

1. close his eyes.

2. hyperventilate.

3. breathe in a rapid shallow fashion.

4. hold a flashing light over his face.

5. submerge his hands in cold water.

ANS: B, C, D

During an EEG, abnormal brain activity can be stimulated by the patient being requested to hyperventilate, breathe rapidly with shallow breaths, and respond to a flashing light over his face.

DIF: Cognitive Level: Comprehension REF: p. 430

TOP: EEG

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

OBJ: Theory #1

The nurse is aware that a patient who is to have a colonoscopy is requested to stop taking drugs that contain iron for ____ days prior to the test.

ANS: 3

Drugs containing iron are held 3 days before a colonoscopy because iron salts can obscure the film. Iron can also cause constipation, which makes the cleansing of the bowel more difficult.

DIF: Cognitive Level: Knowledge

REF: p. 427

TOP: Colonoscopy

OBJ: Theory #1

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

The nurse is to collect a sample of blood for a laboratory test. Arrange the sequence of a phlebotomy. (Separate letters by a comma and space as follows: A, B, C, D, E, F, G, H.)

1. Place vacutainer tube inside holder.

2. Press tube stopper onto needle.

3. Puncture site.

4. Apply tourniquet and cleanse site.

5. Label tube.

6. Fill tube completely.

7. Loosen tourniquet and apply pressure to site.

8. Perform hand hygiene and apply gloves.

ANS:

E, H, A, D, C, B, F, G

The nurse should label the tube with patient identification, perform hand hygiene and apply gloves, place the vacutainer tube inside the holder, apply the tourniquet and cleanse the site, puncture the site, press the tube stopper onto the needle, fill the tube completely, and then loosen the tourniquet and apply pressure to the site.

DIF: Cognitive Level: Analysis

REF: p. 412|Skill 24-1

OBJ: Theory #3

TOP: Phlebotomy KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort