Saunders Diagnostic Testing

A stool smear for culture needs to be obtained from a client. What steps should the nurse plan to implement when obtaining the specimen? Select all that apply. 1. Wearing sterile gloves 2. Using a sterile container 3. Refrigerating the specimen 4. Sending the specimen directly to the laboratory 5. Positioning the client in a dorsal recumbent position

Rationale: 1,2,4 A stool smear specimen is obtained using sterile gloves and a sterile container. {It is very important to use a wooden applicator to put the stool in the sterile container; it is NOT necessary to obtain the first bowel movement of the day} After obtaining the specimen, the stool is sent immediately to the laboratory. Storing a stool specimen for culture in a refrigerator is contraindicated because it can retard the growth of organisms. The client needs to be positioned in a lateral recumbent position to obtain the sample.

A client with urolithiasis is scheduled for extracorporeal shock wave lithotripsy. The nurse should tell the client that which will be necessary before the procedure is performed? 1. Insertion of a Foley catheter 2. A signed informed consent form 3. Clear liquids only on the day of the procedure 4. Administration of antihypertensive medication

Rationale: 2 Extracorporeal shock wave lithotripsy is done with the client under epidural or general anesthesia. The client must sign a consent form for the procedure and must have no oral intake beginning the night before the procedure. The client needs an intravenous line for the procedure as well. Insertion of a Foley catheter is not normally performed, and there is no reason to administer antihypertensive medication for this procedure.

A client is about to undergo a lumbar puncture. The nurse describes to the client that which position will be used during the procedure? 1. Side-lying with a pillow under the hip 2. Prone with a pillow under the abdomen 3. Prone in slight Trendelenburg's position 4. Side-lying with the legs pulled up and the head bent down onto the chest

Rationale: 4 A client undergoing lumbar puncture is positioned lying on the side, with the legs pulled up to the abdomen and the head bent down onto the chest. This position helps to open the spaces between the vertebrae and allows for easier needle insertion by the health care provider. The nurse remains with the client during the procedure to help the client maintain this position. The other options identify incorrect positions for this procedure.

A client is to undergo pleural biopsy at the bedside. When planning for any potential complications of the procedure, the nurse should have which item(s) available at the bedside? 1. Intubation tray 2. Morphine sulfate injection 3. Portable chest x-ray machine 4. Chest tube and drainage system

Rationale: 4 Complications following pleural biopsy include hemothorax, pneumothorax, and temporary pain from intercostal nerve injury. The nurse should have a chest tube and drainage system available at the bedside for use if hemothorax or pneumothorax develops. An intubation tray is not indicated. The client may be premedicated before the procedure, or a local anesthetic is used. A portable chest x-ray machine would be needed to verify placement of a chest tube if one was inserted, but it is unnecessary to have at the bedside before the procedure.

The nurse is providing instructions for a client who will collect a stool specimen for an occult blood test. The nurse instructs the client that it is best to avoid which food for 3 days before collection of the stool specimen? 1. Turnips 2. Hard cheese 3. Milk products 4. Cottage cheese

Rationale: 1 The nurse would instruct the client to avoid red meat, poultry, fish, turnips, horseradish, and foods such as fruits and vegetables for 3 days before and during testing. These foods may alter test results. It is not necessary to avoid the items in the remaining options.

The nurse has a prescription to obtain a 24-hour urine collection in a client with a renal disorder. Which actions should the nurse take when collecting this specimen? Select all that apply. 1. Explain the procedure to the client. 2. Save all subsequent voidings after the first void during the 24-hour period. 3. During the collection period, place the main container on ice or in a refrigerator. 4. Have the client void at the end time, and place this specimen in the main container. 5. Have the client void at the start time, and place this specimen in the main container.

Rationale: 1,2,3,4 The nurse should first explain the procedure to the client and ask the client to void at the beginning of the collection period and to discard this urine sample. All subsequent voided urine is saved in a container, which is placed on ice or refrigerated. The client is asked to void at the finish time, and this sample is added to the collection. The container is labeled, placed on fresh ice, and sent to the laboratory immediately.

The nurse is caring for a client just admitted to the critical care unit with a diagnosis of myocardial infarction (MI). In the early period after an MI, why are nutrition interventions and education so important? Select all that apply. 1. To reduce angina 2. To cut down on cardiac workload 3. To cut down on the cost of a hospital stay 4. To decrease the risk of dysrhythmias 5. To cause weight loss in obese clients 6. To eliminate further deterioration of kidney function

Rationale: 1,2,4 In the early period after an MI, nutrition interventions and education are designed to reduce angina, cardiac workload, and risk of dysrhythmia. Nutrition interventions and education do not cut down on the cost of a hospital stay or prevent problems with kidney function. Although weight loss in obese clients is an intervention, this is not so important to address in the early period following an MI. Meal size, caffeine intake, and food temperatures are some of the dietary factors that are of concern. Small, frequent snacks are preferable to larger meals for clients with severe myocardial compromise or postprandial angina. If caffeine is included in the diet, its effects should be monitored. Caffeine is a stimulant and may increase heart rate and myocardial oxygen demand. Very hot or very cold foods should be avoided because they potentially can trigger vagal or other neural input and cause cardiac dysrhythmias.

The nurse provides information to a client scheduled for a dual x-ray absorptiometry (DEXA) test. Which information should the nurse provide to the client? Select all that apply. 1. It is a painless test. 2. It emits slightly more radiation than a chest x-ray does. 3. Upper body clothing will need to be removed for testing. 4. Increased fluid intake is necessary following the procedure. 5.Metallic objects such as jewelry or belt buckles may interfere with the test and need to be removed.

Rationale: 1,5 The most commonly used screening and diagnostic tool for measuring bone mineral density is the dual x-ray absorptiometry (DEXA) test. It is a painless test that emits less radiation than a chest x-ray. A height is taken before the start of the test. The client stays dressed but is asked to remove any metallic objects such as belt buckles, coins, keys, or jewelry because they may interfere with testing. No special follow-up care for the test is necessary.

The nurse reviews the health care provider's (HCP's) prescriptions for a child with a streptococcal infection. The HCP prescribes an antistreptolysin O titer. Based on this prescription, which diagnosis should the nurse suspect in the child? 1. Heart failure (HF) 2. Rheumatic fever (RF) 3. Aortic valve disease (AVD 4. Pulmonic valve disease (PVD)

Rationale: 2 A diagnosis of RF is confirmed by the presence of two major manifestations or one major and two minor manifestations from the Jones criteria. In addition, evidence of a recent streptococcal infection is confirmed by positive antistreptolysin O titer, Streptozyme slide tests, or anti-DNase B assays. An antistreptolysin O titer is not a specific laboratory test for the conditions identified in options 1, 3, and 4.

The nurse is providing instructions to a client who is scheduled for a gallium scan. Which statement made by the client indicates an understanding of the instructions? 1. "The procedure will take all day." 2. "I need to have an injection 2 to 3 hours before the procedure." 3. "I will need to avoid food and fluids and remain on bed rest for 2 days after the procedure." 4. "I need to get a good night's rest because I will have to stand for several hours for this test."

Rationale: 2 A gallium scan is similar to a bone scan but with injection of gallium isotope instead of radioisotope. Gallium is injected 2 to 3 hours before the procedure. The procedure takes 30 to 60 minutes to perform. The client needs to lie still during the procedure. There is no special aftercare.

A fasting blood glucose screening test is performed on a pregnant client. The results indicate that the blood glucose level is 140 mg/dL (8 mmol/L). The nurse should anticipate that which treatment measure would most likely be prescribed next for the mother? 1. An oral hypoglycemic agent 2. A 3-hour glucose tolerance test 3. Humulin N insulin on a daily basis 4. A sliding-scale regular insulin dose

Rationale: 2 A maternal glucose level is done to screen for gestational diabetes. A 50-g oral glucose load may be prescribed and is followed by a serum glucose determination 1 hour later. If the test is done without regard for fasting, 140 mg/dL (8 mmol/L) is the upper limit of normal. If the test is done when the woman is fasting, the upper acceptable limit is 135 mg/dL (7.7 mmol/L). Clients exceeding these limits should be further evaluated with a 3-hour glucose tolerance test. The remaining options would not be prescribed based solely on the maternal glucose level. Further follow-up would be implemented.

The nurse working in a same-day procedure unit is admitting a client scheduled for an arthrogram using a contrast medium. Which is the priority nursing assessment for this client? 1. Determine if the client understands the procedure. 2. Determine if the client has an allergy to iodine or shellfish. 3. Determine if the client wishes to void before the procedure. 4. Determine if the client is able to remain still during the procedure.

Rationale: 2 Because of the risk of allergy to contrast medium, the nurse places highest priority on identifying an allergy to iodine or shellfish because allergic reaction as severe as anaphylaxis could occur. The nurse also should assess knowledge of the procedure, whether the client needs to void beforehand, and the ability to remain still during the procedure. Although all of these assessments may be made, the one with the highest priority is prevention of an allergic reaction through complete assessment.

The ambulatory care nurse is preparing a client who is scheduled for a liver biopsy. The nurse reviews the client's record and expects to note which laboratory results documented in the client's chart? 1. Uric acid level 2. Prothrombin time 3. Blood urea nitrogen 4. White blood cell count

Rationale: 2 Before performance of a liver biopsy, the nurse ensures that a platelet count and a prothrombin time have been performed and that the results are documented in the client's chart. The nurse also would analyze the results to determine that they are within normal range. Because the client is at risk for bleeding from this procedure, it is imperative that these blood tests be performed before the procedure. The remaining diagnostic tests are not related to this procedure or to any complications that may occur after the procedure.

The nurse is caring for a client with a peptic ulcer who has just had an esophagogastroduodenoscopy (EGD). Which client problem should be the priority? 1. Risk for dehydration caused by bleeding in the gastrointestinal tract 2. Risk for choking and aspiration related to a poor gag reflex postprocedure 3. Lack of knowledge of postprocedure care related to not having had an EGD before 4. Sore throat related to passage of the endoscope through the pharyngeal region during EGD

Rationale: 2 EGD is a visual inspection of the esophagus, stomach, and duodenum using a fiber optic endoscope. All the client problems listed as options are potentially appropriate for a client who just had an EGD. After the procedure, the client is recovering from the use of conscious sedation and the administration of a local anesthetic to the throat. Therefore, the client problem in option 2 is most important at this point because of the potential for airway problems.

The ambulatory care nurse is providing home care instructions to the client after an arthroscopy of the knee. Which statement by the client indicates a need for further instruction? 1. "I should elevate my knee while sitting." 2. "I can apply heat to the site if it becomes uncomfortable." 3. "I should avoid excessive use of the joint for several days." 4. "I should return to the health care provider for suture removal in about 7 days."

Rationale: 2 Ice is applied to the affected joint for pain and swelling, and analgesics are administered as prescribed. The application of heat may cause swelling and discomfort. After arthroscopy the client is instructed to avoid excessive use of the joint for several days, to elevate the knee while sitting, to avoid twisting the knee, and to return for suture removal in about 7 days.

A magnetic resonance imaging (MRI) study is prescribed for a client with a suspected brain tumor. Which priority action should the nurse include in the client's plan of care to ensure safety? 1. Shave the groin for insertion of a femoral catheter. 2. Remove all metal-containing objects from the client. 3. Inform the client to remain motionless throughout the procedure. 4. Instruct the client in inhalation techniques for the administration of the radioisotope.

Rationale: 2 In MRI, radiofrequency pulses in a magnetic field are converted into pictures. All metal objects, such as rings, bracelets, hairpins, and watches, should be removed. In addition, a history should be taken to ascertain whether the client has any internal metallic devices such as orthopedic hardware, pacemakers, or shrapnel. Insertion of a femoral catheter is not part of the procedure. The client needs to be motionless throughout the procedure for quality of the scan, but this action is not related to a safety issue and therefore is not the priority. A radioisotope may be prescribed with positron emission tomography.

The clinic nurse reads the results of a tuberculin skin test performed on a 5-year-old child who is at low risk for contracting tuberculosis. The results indicate an area of induration measuring 10 mm. How would the nurse interpret these results? 1. Positive 2. Negative 3. Inconclusive 4. Requiring a repeat test

Rationale: 2 Induration measuring 15 mm or greater is considered a positive result in a child 4 years of age or older who has no associated risk factors. {Please note that induration of 10 mm or greater is considered positive for TB with the exception of immunocompromised pt such as HIV/AIDS, then induration of 5 mm or greater is considered positive for TB} Options 1, 3, and 4 are incorrect interpretations.

The emergency department nurse is caring for a client with a suspected diagnosis of meningitis. The nurse should prepare the client for which test to confirm the diagnosis? 1. Blood culture 2. Lumbar puncture 3. Serum electrolyte panel 4. White blood cell count

Rationale: 2 Meningitis is an acute or a chronic inflammation of the meninges and the cerebrospinal fluid (CSF). The most significant diagnostic test used in meningitis is the lumbar puncture. Clients older than 60 years, those who are immunocompromised, or those who have signs of increased intracranial pressure usually have a computed tomography scan before the lumbar puncture. Blood cultures are not normally prescribed for diagnosis of this disorder; however, if there will be a delay in obtaining the CSF, blood may be drawn for culture and sensitivity. A WBC count and serum electrolyte assay also may be performed but will not confirm the diagnosis.

A client is scheduled for an oral cholecystogram. The nurse should plan to prescribe which type of diet for the evening meal before the test? 1. Liquid 2. Low-fat 3. Low-protein 4. High-carbohydrate

Rationale: 2 Normal dietary intake of fat should be maintained during the days preceding an oral cholecystogram to empty bile from the gallbladder, and a low-fat diet is prescribed on the evening before the test. The low-fat diet prevents contraction of the gallbladder and allows accumulation of the contrast substance needed for radiographic visualization. Options 1, 3, and 4 are not required diets.

A client is scheduled for oral cholecystography. For the evening meal prior to the test, the nurse should provide a list of foods from which diet type? 1. Liquid 2. Fat-free 3. Low-protein 4. High-carbohydrate

Rationale: 2 Normal dietary intake of fat should be maintained during the days preceding the test to empty bile from the gallbladder. A low-fat or fat-free diet is prescribed on the evening before the test. This prevents contraction of the gallbladder and allows for accumulation of the contrast substance needed for x-ray visualization during the testing procedure. Therefore, options 1, 3, and 4 are incorrect.

With a finger sensor the nurse is measuring a client's oxygen saturation with a pulse oximeter machine and obtains a reading of 78% while the client is on oxygen via nasal cannula at 2 L/min. The client is showing no signs of restlessness or dyspnea. What is the first nursing action? 1. Increase the client's oxygen to 4 L/min. 2. Check the finger sensor's position and repeat the test. 3. Notify the client's health care provider about the low reading. 4. Check the client's chart to find out what the previous readings have been.

Rationale: 2 Note that the low reading does not match the client's signs and symptoms. The first action by the nurse is to ensure that the test was done properly and the reading is accurate. The nurse should not increase the oxygen without a health care provider's prescription. The results of the test should be verified before any other actions are taken, and this can be done quickly.

The nurse is caring for a client after pulmonary angiography with catheter insertion via the left groin. Which assessment finding is related to an allergic reaction to the contrast medium? 1. Hypothermia 2. Decreased blood pressure 3. Hematoma in the left groin 4. Discomfort in the left groin

Rationale: 2 Signs of allergic reaction to the contrast dye include early signs such as localized itching and edema, which are followed by more severe symptoms such as respiratory distress, stridor, and decreased blood pressure. Hypothermia, discomfort in the left groin, and hematoma in the left groin are abnormal assessment findings but are not related to allergic reaction to the contrast medium.

The nurse is collecting a sputum specimen for culture and sensitivity testing from a client who has a productive cough. The nurse plans to implement which intervention to obtain the specimen? 1. Ask the client to obtain the specimen after breakfast. 2. Use a sterile plastic container for obtaining the specimen. 3. Provide tissues for expectoration and obtaining the specimen. 4. Ask the client to expectorate a small amount of sputum into the emesis basin.

Rationale: 2 Sputum specimens for culture and sensitivity testing need to be obtained using sterile technique because the test is done to determine the presence of organisms. If the procedure for obtaining the specimen is not sterile, the specimen will be contaminated, and the results of the test will be invalid. A first-morning specimen is preferred because it contains overnight secretions from the tracheobronchial tree.

The ambulatory care nurse is providing instructions to a client who is scheduled for a colonoscopy to remove a polyp. Which instructions are appropriate for client preparation for this procedure? 1. Clear liquids may be consumed starting 24 hours after the procedure. 2. A bowel preparation will be needed in preparation for the procedure. 3. Clear liquids only are allowed on the day of the scheduled procedure. 4. If blood-tinged stools are noted after the procedure, the health care provider should be notified.

Rationale: 2 The client should be instructed that bowel preparation with a laxative is prescribed before the procedure to cleanse the bowel. Oral intake is allowed after the procedure once the client is stable. A clear liquid diet is permitted on the day before the procedure (per health care provider preference), and then oral intake is avoided for 8 hours immediately before the procedure. If a polyp has been removed, the client is instructed that the stool may be tinged with blood. However, any signs of tenderness, abdominal pain, or bloody stools should be reported to the health care provider.

The health care provider (HCP) tells a client that a blood transfusion is needed and that a blood sample must be drawn first for blood typing and crossmatching. The nurse explains to the client what a typing and crossmatch test is for and why it is done. What response by the client about blood typing implies to the nurse that further teaching is needed? 1."It is an antigen found on the surface of the red blood cell." 2."It is an antibody found on the surface of the red blood cell." 3."An acute transfusion reaction can happen if I get blood incompatible with mine." 4."If I have group AB blood, I'm a universal recipient because I have no antibodies to react to the transfused blood."

Rationale: 2 The major blood types are A, B, AB, and O. The blood type indicates an antigen, not an antibody, found on the surface of the red blood cell. The other responses are accurate statements.

Which statement should the nurse initially make to a client who is anxious about having a magnetic resonance imaging test? 1. "It is normal to be anxious before this test." 2. "Can you tell me what you know about this test?" 3. "Let me provide you with a full explanation about this test." 4. "This test can be painful sometimes, so if you have pain, just let the technician know."

Rationale: 2 The nurse should initially determine what the client knows about the test. Once this is determined, the nurse can proceed in providing the necessary information to the client or correct any client misunderstanding. Option 1 is a stereotypical response. Options 3 and 4 can increase the client's anxiety.

A client is being prepared for a thoracentesis. The nurse should assist the client to which position for the procedure? 1. Lying in bed on the affected side 2. Lying in bed on the unaffected side 3. Sims' position with the head of the bed flat 4. Prone with the head turned to the side and supported by a pillow

Rationale: 2 To facilitate removal of fluid from the chest, the client is positioned sitting at the edge of the bed leaning over the bedside table, with the feet supported on a stool; or lying in bed on the unaffected side with the head of the bed elevated 30 to 45 degrees. The prone and Sims' positions are inappropriate positions for this procedure.

The nurse is preparing to obtain a sputum specimen from a client. Which nursing action will facilitate obtaining the specimen? 1. Limiting fluids 2. Having the client take 3 to 4 deep breaths 3. Asking the client to spit into the collection container 4. Asking the client to obtain the specimen after eating

Rationale: 2 To obtain a sputum specimen, the client should rinse the mouth to reduce contamination, breathe deeply, and then cough into a sputum specimen container. The client should be encouraged to cough and not spit so as to obtain sputum. Sputum can be thinned by fluids or by a respiratory treatment such as inhalation of nebulized saline or water. The optimal time to obtain a specimen is on arising in the morning.

An ultrasound examination of the gallbladder is scheduled for a client with a suspected diagnosis of cholecystitis. Correct instructions about the procedure should include which statement made by the nurse? 1. "This procedure may cause discomfort." 2. "This test requires that you lie still for short intervals." 3. "This procedure is preceded by the administration of oral tablets." 4. "This procedure requires that you not eat or drink anything for 24 hours before the test."

Rationale: 2 Ultrasound examination of the gallbladder is a noninvasive procedure and frequently is used for emergency diagnosis of acute cholecystitis. It is a painless test and does not require the administration of oral tablets as preparation. The client does not need to be NPO (nothing by mouth) for 24 hours before the test but may be instructed to avoid carbonated beverages for 48 hours before the test to help decrease intestinal gas.

The nurse provides discharge instructions to a client following myelography. Which instructions should the nurse provide? Select all that apply. 1. Restrict fluid intake. 2. Avoid bending over. 3. Avoid strenuous exercise. 4. Rest with the head elevated. 5. Expect some clear drainage from the dressing site.

Rationale: 2,3,4 A myelogram uses x-rays and contrast material to view the bones and the fluid-filled space (subarachnoid space) between the bones in the spine. Following the procedure, the client needs to increase fluid intake to flush the contrast material. Since dye is injected and spinal fluid leakage is a concern, the client should avoid bending over, avoid strenuous exercise, and rest with the head elevated. Clear drainage from the dressing site indicates cerebrospinal fluid leakage, requiring health care provider notification.

The nurse is caring for a client who is scheduled to have a lumbar puncture (LP). What are some contraindications for a client to have an LP? Select all that apply. 1. Clients with an allergy to sulfa 2. Clients with infection near the LP site 3. Clients with increased intracranial pressure 4. Clients receiving anticoagulation medications 5. Clients with a history of migraine headaches 6. Clients who have severe degenerative vertebral joint disease

Rationale: 2,3,4,6 Contraindications for clients having an LP performed include the following: those receiving anticoagulation medications, those with infection near the LP site, those with increased intracranial pressure, and those who have severe degenerative vertebral joint disease. Clients with an allergy to sulfa or with a history of migraine headaches are not contraindicated for having an LP performed.

The ambulatory care nurse is preparing to assist the health care provider in performing a liver biopsy on a client. The client is receiving a local anesthetic for the procedure. The nurse should assist the client into which position for this test to be performed? 1. Right lateral side-lying 2. Flat with the head elevated 3. Supine with the right hand under the head 4.Prone with the hands crossed under the head

Rationale: 3 A client undergoing liver biopsy with the use of a local anesthetic will be positioned supine with the client's right hand placed under the head. An alternative position is the left lateral side-lying position. The client also will be asked to remain as still as possible during the test. The remaining options are inappropriate positions for this procedure.

A computed tomography scan of the chest with contrast is scheduled to be performed in a client suspected of having a pulmonary embolism. In planning the preprocedure care for this client, which nursing action is necessary? 1. Encourage intake of fluids 2. Shave the anticipated entry site. 3. Ask the client about allergies and previous reactions. 4. Contact the operating room regarding the need for the procedure.

Rationale: 3 A computed tomography scan is not performed in the operating room; therefore, it is not necessary that the nurse contact this department. There is no surgical entry site; therefore, shaving is not necessary. The procedure is explained to the client, who also is asked about allergies to shellfish or contrast media. Oral ingestion except for sips of water is avoided for 4 to 6 hours before the test.

The nurse is developing a plan of care for a client who has undergone an esophagogastroduodenoscopy procedure. The nurse should include which intervention in the nursing care plan? 1. Monitor the client's vital signs every hour for 4 hours. 2. Place the client in a prone position to provide comfort. 3. Check the gag reflex by using a tongue depressor to stroke the back of the client's throat. 4. Provide saline gargles immediately on the client's return to the nursing unit to aid in comfort.

Rationale: 3 After esophagogastroduodenoscopy (EGD), the vital signs are checked frequently, usually every 30 minutes, until sedation wears off. The nurse places the client in a semi Fowler's to Fowler's position to aid in comfort and prevent aspiration. The client remains on NPO (nothing by mouth) status until the gag reflex returns (usually in 2 to 4 hours). The nurse can check the gag reflex by using a tongue depressor to stroke the back of client's throat. Saline gargles would not be allowed until the gag reflex returns.

A client is scheduled for an intravenous pyelogram. Before the test, which is the priority nursing action? 1. Restrict fluids. 2. Administer a sedative. 3. Determine a history of iodine allergy. 4. Administer an oral preparation of radiopaque dye.

Rationale: 3 An iodine-based dye may be used during intravenous pyelography and can cause allergic reactions such as itching, hives, rash, a tight feeling in the throat, shortness of breath, and bronchospasm. Assessing for allergies is the priority. Fluids are not restricted and a sedative is not prescribed. An oral preparation of radiopaque dye is not used in this test.

The nurse collects a 24-hour urine specimen for catecholamine testing from a client with suspected pheochromocytoma. The results of the catecholamine test are reported as epinephrine 20 mcg (109 nmol) and norepinephrine 100 mcg (590 nmol). The nurse should make which interpretation about this result? 1. Insignificant and unrelated to pheochromocytoma 2. Lower than normal, ruling out pheochromocytoma 3. Higher than normal, indicating pheochromocytoma 4. Normal results for a client with pheochromocytoma

Rationale: 3 Assays of catecholamines are performed on single-void urine specimens, 2- to 4-hour specimens, and 24-hour urine specimens. The normal range of urinary catecholamines is epinephrine <20 mcg/day (<109 nmol/day) and norepinephrine <100 mcg/day (<590 nmol/day), with higher levels occurring in pheochromocytoma. {Note: You do NOT have to know the normal values of catecholamines; yet, you must know that pheochromocytoma is a benign tumor of the adrenal MEDULLA that excessively secretes the catecholamines Epinephrine and Norepinephrine.}

The nurse has a prescription to collect a 24-hour urine specimen from a client. The nurse is demonstrating correct procedure when which technique is performed? 1. Ask the client to void, save the specimen, and note the start time. 2. Place the specimen in various containers as necessary for the test. 3. Ask the client to save a sample voided at the end of the collection time. 4. Remove urine from the collection container for other prescribed specimens.

Rationale: 3 Because the 24-hour urine test is a timed quantitative determination, the test must be started with an empty bladder; therefore, the first urine is discarded. Fifteen minutes before the end of the collection time, the client should be asked to void, and this specimen is added to the collection. The urine sample should be placed in the appropriate container and may be refrigerated or placed on ice to prevent changes in the urine. Because this is a quantitative determination of constituents in the urine, no urine should be removed from the container.

A client is scheduled for a fiberoptic gastrointestinal procedure. The nurse instructs the client to remain on clear liquids the day before the test because a clear liquid diet supports which action? 1. Stimulating peristalsis 2. Promoting a laxative action 3. Providing little or no residue 4. Providing minimal calories and nutrients

Rationale: 3 Before a gastrointestinal (GI) procedure, the health care provider (HCP) generally desires that the GI tract be cleansed of substances. Because clear liquid diets have little or no residue, the GI tract will have an opportunity to empty itself of solid contents. This will enable the HCP to view the GI tract clearly. Clearing the GI tract via diet is safer than having enemas until clear because this process can disrupt fluid and electrolyte balance. All other options are inaccurate regarding a clear liquid diet.

The nurse is providing information to a client scheduled for a lumbar puncture. Which information should the nurse provide to the client? 1. The test will probably take about 2 hours. 2. Food and fluids will be restricted after the test. 3. A signed informed consent form will be required. 4. Maintaining bed rest after the test will not be necessary.

Rationale: 3 Client preparation for a lumbar puncture includes obtaining an informed consent from the client because the procedure is invasive. The client is told that the test will take approximately 15 to 60 minutes. No dietary restrictions are required after the test, and the client should be encouraged to consume fluids. The nurse needs to inform the client about the need for bed rest after the test.

The nurse is providing information to a client about a computed tomography (CT) scan of the head. Which statement should the nurse include when reviewing preparation for the CT with the client? 1. "You will need to stand up straight for the entire procedure." 2. "All scans require the injection of dye before the procedure." 3. "Each set of head scans takes less than 5 minutes to perform." 4. "You will need to remain on bed rest for 12 hours after the scan."

Rationale: 3 For a CT scan of the head, the client lies on a movable table in a head-holding device. Each set of head scans takes less than 5 minutes to perform. An iodinated contrast medium may or may not be used. No special aftercare is indicated, so the client may resume the usual diet and activity afterward.

A client returns to the nursing unit after undergoing an esophagogastroduodenoscopy (EGD). Which is the appropriate nursing intervention? 1. Allow the client to have bathroom privileges. 2. Keep the client lying flat in bed in the supine position 3. Withhold oral fluids until the client's gag reflex has returned 4. Tell the client to report a sore throat immediately because it is a serious complication.

Rationale: 3 In preparation for the passage of the endoscope, an anesthetic is sprayed to inactivate the gag reflex and thus facilitate passage of the tube. It may take 1 to 2 hours for the anesthetic spray to wear off and for the gag reflex to return. The client should remain on bed rest in a semi Fowler's position until fully alert. A sore throat is expected because of the endoscopic tube.

The nurse is caring for a client who has undergone renal angiography using the left femoral artery for access. The nurse determines that the client is experiencing a complication of the procedure if which finding is observed? 1. Urine output, 50 mL/hr 2. Blood pressure, 110/74 mm Hg 3. Pallor and coolness of the left leg 4. Absence of hematoma in the left groin

Rationale: 3 Potential complications after renal angiography include allergic reaction to the dye; renal damage from the dye; and vascular complications, which include hemorrhage, thrombosis, or embolism. The nurse detects these complications by noting signs and symptoms of allergic reaction, decreased urine output, hematoma or hemorrhage at the insertion site, or signs of decreased circulation to the affected leg.

The nurse is planning care for a client returning to the nursing unit after a bone biopsy. Which nursing action would be contraindicated in the postprocedure care for this client? 1. Monitor vital signs. 2. Administer oral analgesics as needed. 3. Place the limb in a dependent position for 24 hours. 4. Monitor biopsy site for swelling, bleeding, or hematoma.

Rationale: 3 The biopsied limb would be elevated for 24 hours to reduce edema, not placed in a dependent position. Other aspects of care include monitoring vital signs; administering analgesics for site discomfort; and monitoring the site for swelling, bleeding, and hematoma formation.

The nurse is giving client instructions over the telephone about preparing for a mammography. The nurse should make which statement to the client? 1. "Wear metal jewelry as desired." 2. "Consume clear liquids only on the day of the test." 3. "Avoid using underarm deodorant on the day of the test." 4. "Use only lanolin-based skin lotions on the day of the test."

Rationale: 3 The client should avoid the use of lotions or underarm deodorant on the day of mammography because this can affect breast and axilla positioning and obtaining clear mammography pictures. Mammography is a type of radiographic procedure. Therefore, the client is advised not to wear jewelry or metal objects on the day of the test. No special dietary preparation is needed.

The nurse is providing instructions to a client who has had a bone scan. The nurse should instruct the client to take which measure? 1. Avoid eating or drinking for 24 hours. 2. Take a liquid laxative daily for the next 3 days. 3. Increase fluid intake for the next 24 to 48 hours. 4. Ambulate vigorously several times for the next 2 days.

Rationale: 3 The client should be encouraged to drink large amounts of water for 24 to 48 hours to facilitate urinary excretion of the radioisotope. No special restrictions are necessary after a bone scan. The remaining three options are incorrect instructions.

The nurse working in the outpatient radiology department is giving discharge instructions to a client who has had a bone scan. Which instruction should the nurse include in the client's teaching plan? 1. Report any feelings of nausea or flushing. 2. Avoid eating very much for the rest of the day. 3. Drink extra water for a day or so after the procedure. 4. Try to go up and down stairs at least twice before the end of the day.

Rationale: 3 The client should drink large amounts of water for 24 to 48 hours to excrete the radioisotope through the kidneys. No special diet or activity prescriptions or restrictions are required after a bone scan. Nausea or flushing would accompany allergic reaction to a dye, which is not used in this procedure.

The nurse is providing instructions to the client scheduled for magnetic resonance imaging. Which instruction should the nurse provide to the client? 1. Injection of a dye is necessary. 2. Food and fluids are restricted for 12 to 24 hours before the test. 3. Lying still in a flat position for 45 to 60 minutes may be necessary. 4. The test may cause some pain, and pain medication will be prescribed if pain occurs.

Rationale: 3 The client will need to lie in a flat position for 45 to 60 minutes. The client is informed that magnetic resonance imaging (MRI) is a painless test and that a contrast dye may or may not be used. Additionally, no dietary restrictions are necessary with MRI. The nurse informs the client that the MRI may damage items such as credit cards and watches and that jewelry and hair clips cause artifacts. These objects should be removed from the client before the test.

The nurse is caring for a client who had intracranial surgery and is now suspected of having developed diabetes insipidus (DI). What initial prescription should the nurse expect from the health care provider (HCP)? 1. Serum electrolytes 2. Urine specific gravity 3. 24-hour fluid intake and output without restricting food or fluid intake 4. Postoperative magnetic resonance imaging to detect any damage to the hypothalamus or pituitary gland

Rationale: 3 The first step in diagnosing DI is to measure a 24-hour fluid intake and output without restricting food or fluid intake. All of the other options may be done but would not be as definitive as a 24-hour fluid intake and output test.

The client with right-sided pleural effusion by chest x-ray is being prepared for a thoracentesis. The nurse should assist the client to which position for the procedure? 1. Sims' position, with the head of the bed flat 2. Prone, with the head turned to the side supported by a pillow 3. Left side-lying position, with the head of the bed elevated 45 degrees 4. Right side-lying position, with the head of the bed elevated 45 degrees

Rationale: 3 To facilitate removal of fluid from the pleural space, two positions may be used. The client may be positioned sitting on the edge of the bed, leaning over the bedside table, with the feet supported on a stool. The other position is lying in bed on the unaffected side, with the head of the bed elevated 45 degrees (Fowler's position). The other options are incorrect because they do not facilitate drainage of fluid to an area easily removed with thoracentesis.

The nurse notes that the health care provider has documented a suspected diagnosis of herpes zoster in the client's chart. The nurse should prepare the client for which diagnostic test to confirm this diagnosis? 1. Patch test 2. Skin biopsy 3. Culture of the lesion 4. Wood's lamp examination

Rationale: 3 With the classic presentation of herpes zoster, the clinical examination is diagnostic. A viral culture of the lesion provides the definitive diagnosis. Herpes zoster is caused by a reactivation of the varicella-zoster virus, the cause of chickenpox. A patch test is a skin test that involves the administration of an allergen to the skin's surface to identify specific allergies. A biopsy identifies tissue type. In a Wood's lamp examination, the skin is viewed under ultraviolet light to identify superficial infections of the skin.

The nurse is developing a plan of care for a client who will be returning to the nursing unit after a percutaneous transhepatic cholangiogram. The nurse should include which intervention in the postprocedure plan of care? 1. Encourage fluid and food intake. 2. Allow the client bathroom privileges only. 3. Allow the client to sit in a chair for meals. 4. Place a sandbag or other approved device over the insertion site.

Rationale: 4 A percutaneous transhepatic cholangiogram is an x-ray of the biliary duct system that is taken with the use of an iodinated dye instilled via a percutaneous needle inserted through the liver into the intrahepatic ducts. This procedure may be done when a client has jaundice or persistent upper abdominal pain, although ultrasound scans and endoscopic retrograde cholangiopancreatography are usually the preferred tests. After this procedure, the nurse monitors the client's vital signs closely for indications of hemorrhage and observes the needle insertion site for bleeding and bile leakage. A sandbag or other pressure device is placed over the insertion site to prevent bleeding. Oral intake is avoided in the immediate postprocedure period in case surgery is necessary to control hemorrhage or bile extravasation, and the client is maintained on bed rest.

The nurse assists a health care provider in performing a liver biopsy. After the biopsy, the nurse should place the client in which position? 1. Prone 2. Supine 3. A left side-lying position with a small pillow or folded towel under the puncture site 4. A right side-lying position with a small pillow or folded towel under the puncture site

Rationale: 4 After a liver biopsy, the client is assisted to assume a right side-lying position with a small pillow or folded towel under the puncture site for 3 hours. This position compresses the liver against the chest wall at the biopsy site. Therefore, all other options are incorrect.

The nurse is giving postprocedure instructions to a client returning home after arthroscopy of the shoulder. What is the priority instruction for this client? 1. "Do not eat or drink anything until tomorrow morning." 2. "Keep the shoulder completely immobilized for the rest of the day." 3. "You need to refrain from strenuous activity for the next few weeks." 4. "Report any fever or redness and heat at the site to your health care provider."

Rationale: 4 After arthroscopy, signs and symptoms of infection such as fever or redness and heat at the site should be reported to the health care provider. The client may resume the usual diet immediately. The arm does not have to be completely immobilized once sensation has returned, but the client usually is encouraged to refrain from strenuous activity for at least a few days.

A client has just returned to a nursing unit following bronchoscopy. Which nursing intervention should the nurse implement? 1. Administering atropine intravenously 2. Administering small doses of a sedative 3. Encouraging additional fluids for the next 24 hours 4. Ensuring the return of the gag reflex before offering food or fluids

Rationale: 4 After bronchoscopy, the nurse keeps the client on NPO (nothing by mouth) status until the gag reflex returns because the preoperative sedation and local anesthesia impair swallowing and the protective laryngeal reflexes for a number of hours. Additional fluids are unnecessary because no contrast dye is used that would need flushing from the system. Atropine and a sedative would be administered before the procedure, not after.

The nurse is preparing to care for a client who has returned to the nursing unit following cardiac catheterization performed through the femoral vessel. The nurse checks the health care provider's (HCP's) prescription and plans to allow which client position or activity following the procedure? 1. Bed rest in high Fowler's position 2. Bed rest with bathroom privileges only 3. Bed rest with head elevation at 60 degrees 4. Bed rest with head elevation no greater than 30 degrees

Rationale: 4 After cardiac catheterization, the extremity into which the catheter was inserted is kept straight for 4 to 6 hours. The client is maintained on bed rest for 4 to 6 hours (time for bed rest may vary depending on the HCP's preference and on whether a vascular closure device was used) and the client may turn from side to side. The head is elevated no more than 30 degrees (although some HCPs prefer a lower position or the flat position) until hemostasis is adequately achieved.

A clinic nurse is providing instructions to a client who is scheduled for a glucose tolerance test. Which instruction should the nurse provide to the client in preparation for the test? 1. Eat a normal breakfast on the day of the test. 2. Take insulin as scheduled on the day of the test. 3. Eat a low-carbohydrate diet for at least 3 days before the test. 4. Avoid alcohol, coffee, and tea for 36 hours before and during the test.

Rationale: 4 Alcohol, coffee, and tea should be avoided for 36 hours before testing. Fasting is required from midnight before the test until the test is completed, although water is permitted. The client is told to discontinue insulin or oral hypoglycemic agents on the day of the test. The nurse instructs the client to consume a high-carbohydrate diet (at least 200 to 300 g of carbohydrate per day) for at least 3 days before the test and to discontinue oral contraceptives, corticosteroids, salicylates, and thiazide derivatives 3 days before the test.

The nurse is caring for a client with possible cholelithiasis who is being prepared for intravenous cholangiography and is teaching the client about the procedure. Which statement indicates that the client understands the purpose of this test? 1. "My gallbladder will be irrigated." 2. "This procedure will drain my gallbladder." 3. "They will put medication in my gallbladder." 4. "They are going to look at my gallbladder and ducts."

Rationale: 4 An intravenous cholangiogram is done for diagnostic purposes. It outlines both the gallbladder and the ducts, so gallstones that have moved into the ductal system can be detected. X-rays are used to visualize the biliary duct system after intravenous injection of radiopaque dye. This test is diagnostic and does not involve irrigation, instillation of medications, or drainage of the gallbladder.

The nurse is preparing to care for a client following a gastroscopy procedure. Which priority component should the nurse include in the nursing care plan? 1. Monitor the client's vital signs every hour for 4 hours. 2. Place the client in a supine position to provide comfort. 3. Provide saline gargles immediately on return to the unit to aid in comfort. 4. Check the gag reflex by using a tongue depressor to stroke the back of the client's throat.

Rationale: 4 Before the gastroscopy procedure, medication is given to prevent a gag reflex. On return from the procedure, the nurse must test the client's gag reflex to ensure that it is present to prevent aspiration of contents. Vital signs should be taken every 30 minutes for 2 hours to detect abnormalities. The client must be placed in a side-lying or semi Fowler's position to avoid aspiration. Saline gargles must be administered only when the gag reflex has been confirmed.

A client suspected of having an abdominal tumor is scheduled for a computed tomography (CT) scan with dye injection. How should the nurse describe this test to the client? 1. The test may be painful. 2. The test will take approximately 2 hours. 3. Fluids will be restricted following the test. 4. The dye injected may cause a warm, flushing sensation.

Rationale: 4 CT scanning causes no pain and can take 15 to 60 minutes to perform. The dye may cause a warm, flushing sensation when injected. Fluids are encouraged following the procedure. If an iodine dye is used, the client should be asked about allergies to seafood or iodine.

A client requires a myelogram, and the ambulatory care nurse is providing instructions to the client regarding preparation for the procedure. Which statement by the client indicates a need for further instruction? 1. "My jewelry will need to be removed." 2. "An informed consent form will need to be signed." 3. "My procedure will take approximately 45 minutes." 4. "I need to be sure to eat a full meal before the procedure."

Rationale: 4 Client preparation for a myelogram includes instructing the client to withhold food and fluids for 4 to 8 hours before the procedure as prescribed. Some health care providers may allow fluids or a light diet (but not a full meal). The client is told that the procedure takes about 45 minutes. An informed consent is required, and the client will need to remove jewelry and any metal objects. The client also is told that pretest medications may be administered for relaxation.

The nurse is caring for a client with suspected kidney failure. A 24-hour urine specimen is prescribed. What value measures overall kidney function? 1. Sodium levels 2. Protein levels 3. Blood uric acid levels 4. Creatinine clearance levels

Rationale: 4 Creatinine clearance is a calculated measure of glomerular filtration rate and is the best indication of overall kidney function. The amount of creatinine cleared from the blood (e.g., filtered into the urine) is measured in the total volume of urine excreted in a defined period. The analysis compares the urine creatinine level with the blood creatinine level, and therefore a blood specimen for creatinine must also be collected. Sodium levels are decreased in prerenal acute kidney injury. Increased levels of protein indicate glomerular disease, nephrotic syndrome, diabetic neuropathy, and urinary tract malignancies and irritations. Uric acid levels are increased in conditions such as gout or uric acid calculi.

A client is scheduled for a digital subtraction angiography study. After being provided information and instructions regarding the test, which statement by the client indicates that the teaching has been effective? 1. "The purpose of the test is to detect lesions in the brain." 2. "The purpose of the test is to inject medication into the bone." 3. "The purpose of the test is to examine the cerebrospinal column." 4. "The purpose of the test is to provide information about the blood vessels."

Rationale: 4 Digital subtraction angiography is a radiographic method to study the blood vessels. The nurse should explain to the client that the test provides information about the blood vessels. {Angiography indicates visualization of blood vessels and with ANGIOGRAPHY, a contrast is usually needed, so assess for allergy to seafood or iodine}. Options 1, 2, and 3 are incorrect.

The nurse is assisting the health care provider with a bedside liver biopsy. When the procedure is complete, the nurse assists the client into which position? 1. Left side-lying, with the right arm elevated above the head 2. Right side-lying, with the left arm elevated above the head 3. Left side-lying, with a small pillow or towel under the puncture site 4. Right side-lying, with a small pillow or towel under the puncture site

Rationale: 4 Following a liver biopsy, the client is assisted to assume a right side-lying position with a small pillow or folded towel under the puncture site for at least 3 hours. This helps to immobilize the area and provides pressure to minimize bleeding in this vascular organ. The other options are incorrect.

A client has just returned from the cardiac catheterization laboratory. The left-sided femoral vessel was used as the access site. How should the nurse position the client? 1. Knee chest, with the foot of the bed elevated 2. Supine, with the head of the bed elevated 45 to 90 degrees 3. Semi Fowler's, with the knees placed on top of 1 pillow 4. Supine, with the head of the bed elevated about 15 degrees

Rationale: 4 Following cardiac catheterization, the extremity used for catheter insertion is kept straight for 4 to 6 hours. If the femoral artery was used, strict bed rest is necessary for 6 to 12 hours. The client may turn from side to side. The head of the bed is not elevated more than 15 degrees (unless otherwise prescribed) to prevent kinking of the blood vessel at the groin and possible arterial occlusion.

A client is scheduled to have a needle liver biopsy. During the procedure, the nurse should instruct the client to take which action? 1. Lie on the right side. 2. Assume a lithotomy position. 3. Breathe deeply as the needle is inserted. 4. Lie supine with the right arm over the head.

Rationale: 4 For the health care provider to have optimal access to the liver during a liver biopsy, the client should be instructed to lie in a supine position with the right arm over the head. {After liver biopsy, the pt should be kept on the affected (RIGHT) side}. Options 1 and 2 are not positions that would provide access to the liver. During a liver biopsy, the client needs to remain still and expire fully, not breathe deeply, while the needle is inserted.

A client with acquired immunodeficiency syndrome is suspected of having cutaneous Kaposi's sarcoma. The nurse should prepare the client for which test to confirm the presence of this type of sarcoma? 1. Liver biopsy 2. Sputum culture 3. White blood cell count 4. Punch biopsy of the cutaneous lesions

Rationale: 4 Kaposi's sarcoma lesions begin as red, dark blue, or purple macules on the lower legs that change into plaques. These large plaques ulcerate or open and drain. The lesions spread by metastasis to the upper body and then to the face and oral mucosa. The lymphatic system, lungs, and gastrointestinal (GI) tract can become involved as well. Late disease results in swelling and pain in the lower extremities, penis, scrotum, or face. Diagnosis is by punch biopsy of cutaneous lesions and biopsy of pulmonary and GI lesions. The remaining options are incorrect and would not confirm the presence of Kaposi's sarcoma.

The clinic nurse is providing instructions to a client who is scheduled for a barium enema. What should the nurse instruct the client to do in preparation for this procedure? 1. Liquids are restricted for 24 hours after the test. 2. A clear liquid diet is required for 4 days before the test. 3. Laxatives should not be taken for at least 1 week before the test. 4. A low-fiber diet needs to be maintained for 1 to 3 days before the test.

Rationale: 4 Preparation for a barium enema includes maintaining a low-fiber diet for 1 to 3 days before the test. Clear liquids or water may be allowed 12 to 24 hours before the test. Laxatives and enemas may be prescribed before the test to cleanse the bowel. The client is encouraged to drink liquids after the procedure to facilitate the passage of barium.

A registered nurse is evaluating the licensed practical nurse's ability to collect a specimen. The nurse would use this specimen collection container to collect which type of specimen? Refer to Figure. (Figure from Perry, Potter, Ostendorf [2014], p. 1074.) 1. Urine 2. Stool 3. Gastric secretions 4. Respiratory secretions

Rationale: 4 Suctioning is indicated when a client is unable to produce a sample by coughing. A sputum specimen may be collected by suctioning the airway, and the specimen is collected in a sterile specimen container (see Figure) that is attached to the suctioning device. The Figure does not illustrate the container used for the collection of a urine, stool, or gastric specimen.

A client with type 2 diabetes mellitus presents to the health care provider's office with a glycosylated hemoglobin (HgbA1C) level of 10.5%. Which statement by the client indicates an understanding of this test and its results? 1."The results of the test are probably high because I ate a donut for breakfast this morning." 2."The results of the test are probably low because I had not eaten anything for 12 hours before my blood was drawn." 3."I know that I need to check my glycosylated hemoglobin before each meal and at bedtime, but I don't always do it. I will do it more regularly." 4."Well, I have 3 months to really work on watching my diet and lowering my blood sugar. My next glycosylated hemoglobin test should be better then."

Rationale: 4 The HgbA1C test provides a measurement of glycemic control over the previous 2 to 3 months, with increases in the HgbA1C reflecting elevated blood glucose levels. An HgbA1C of less than 6% is recommended by most health care providers. Thus, option 4 is the correct one. Options 1 and 2 are incorrect, as HgbA1C measures glycemic control over a few months, and thus having fasted for a long time or having just eaten something does not affect HgbA1C. Option 3 is incorrect because clients check their blood glucose levels, not their HgbA1C, before meals and at bedtime.

The nurse is planning care for a client who has just returned to the nursing unit after an oral cholecystogram. The nurse should expect to delete which prescription on the client's care plan? 1. Monitor hydration status. 2. Assess for nausea and vomiting. 3. Monitor for abdominal discomfort. 4. Maintain a clear liquid diet for 72 hours.

Rationale: 4 The client should be able to resume the usual diet once the nurse is sure that the client's gastrointestinal (GI) function is normal. It is not necessary to keep the client on clear liquids for 72 hours after the procedure. The nurse would also assess hydration status as part of routine care for the client undergoing a GI diagnostic test. The nurse would monitor the client for complaints of GI discomfort and nausea and vomiting.

The nurse is preparing a client who is scheduled to undergo cerebral angiography. The nurse should assess the client for which finding? 1. Claustrophobia 2. Excessive weight 3. Allergy to salmon 4. Allergy to iodine or shellfish

Rationale: 4 The client undergoing cerebral angiography is assessed for possible allergy to the contrast dye, which can be determined by questioning the client about allergies to iodine or shellfish. Claustrophobia and excessive weight are areas of concern with magnetic resonance imaging. Salmon is irrelevant to the question and is not associated with the contrast dye used for this procedure.

How should the nurse position the client for pericardiocentesis to treat cardiac tamponade? 1. Supine with slight Trendelenburg's position 2. Lying on the right side with a pillow under the head 3. Lying on the left side with a pillow under the chest wall 4. Supine with the head of the bed elevated at a 45- to 60-degree angle

Rationale: 4 The client undergoing pericardiocentesis is positioned supine with the head of bed raised to a 45- to 60-degree angle. This places the heart in close proximity to the chest wall for easier insertion of the needle into the pericardial sac. Options 1, 2, and 3 are incorrect positions.

The nurse is caring for a client admitted with a diagnosis of systemic lupus erythematosus (SLE). A highly sensitive C-reactive protein (hsCRP) blood test is prescribed. What other blood test is often used along with the hsCRP? 1. Cardiac enzymes 2. Serum electrolytes 3. Complete blood count (CBC) 4. Erythrocyte sedimentation rate (ESR)

Rationale: 4 The hsCRP is a test to measure inflammation in clients with an autoimmune disease such as SLE and is often done with or instead of the ESR. Both tests are very useful for detecting inflammation anywhere in the body. Cardiac enzymes, serum electrolytes, and a CBC are incorrect.

A nursing student is assigned to an adult client who is scheduled for bone marrow aspiration. The coassigned nurse asks the nursing student about the possible sites that could be used for obtaining the bone marrow. The student demonstrates understanding of the procedure by identifying what as the correct aspiration site? 1. Ribs 2. Femur 3. Scapula 4. Iliac crest

Rationale: 4 The most common sites for bone marrow aspiration in the adult are the iliac crest and the sternum. These areas are rich in bone marrow and are easily accessible for testing. The ribs, femur, and scapula are incorrect options.

A female client is scheduled to have a chest radiograph. Which question is most important for the nurse to ask when assessing this client? 1. "Can you hold your breath easily?" 2. "Are you wearing any metal chains or jewelry?" 3. "Are you able to hold your arms above your head?" 4. "Is there any possibility that you could be pregnant?"

Rationale: 4 The most important item for the nurse to ask about is the client's pregnancy status, because pregnant women should not be exposed to radiation. Clients also are asked to remove any chains or metal objects that could interfere with obtaining an adequate film. A chest radiograph most often is obtained at full inspiration, which gives optimal lung expansion. If a lateral view of the chest is prescribed, the client is asked to raise the arms above the head. Most films are done in a posterior-anterior view.

A client is scheduled for a Papanicolaou (Pap) smear at the next scheduled clinic visit. The nurse provides instructions to the client regarding preparation for this test. Which statement should the nurse include in the teaching? 1. The test is painless. 2. Fluids are restricted on the day of the test. 3. The test can be performed during menstruation. 4. Vaginal douching is required 2 hours before the test.

Rationale: 1 A Pap smear is usually painless. There is no reason to restrict fluids on the day of the test. The test cannot be performed during menstruation. The client needs to be instructed to avoid douching for at least 24 hours before the test.

The nurse is explaining an upper gastrointestinal series to a client and provides the client with the preprocedure and postprocedure instructions. The nurse informs the client that after this procedure, the stools can be expected to remain white for what time period? 1. 1 week 2. 6 hours 3. 8 hours 4. 1 to 2 days

Rationale: 4 It takes at least 12 to 24 hours for a substance to pass through the colon. One week is too long a period, and 6 to 8 hours is too short a period because of residual barium and decreased peristalsis.

A client is about to undergo a lumbar puncture (LP). The nurse should tell the client that which position will be used during the procedure? 1. Prone in slight Trendelenburg's 2. Side-lying with a pillow under the hip 3. Prone with a pillow under the abdomen 4. Side-lying with the legs pulled up and the head bent down onto the chest

Rationale: 4 The client undergoing LP is positioned lying on the side, with the legs pulled up to the abdomen and the head bent down onto the chest. This position helps to open the spaces between the vertebrae and allows for easier needle insertion by the health care provider. Each of the other options identifies an incorrect position for this procedure.

The nurse instructs a female client to obtain a clean-catch urine specimen for culture and sensitivity testing. Which statement by the client indicates that she understands the procedure for collecting the specimen? 1."A urine specimen will be obtained from a catheter." 2."I need to clean the labia with toilet paper and void into the sterile specimen container." 3."I should empty my bladder into a container so that the full amount of urine can be determined." 4."I need to cleanse the labia using cleansing towels, void into the toilet, and then void into the sterile specimen container."

Rationale: 4 Urine specimens for culture and sensitivity need to be obtained with the use of proper cleansing and voiding techniques to avoid contamination from external sources. The use of toilet paper will contaminate the specimen. The procedure described in option 3 would not provide a clean specimen. It is not necessary to obtain the specimen via a catheter.

A client is scheduled for a test to detect kidney tumors or cysts. What test is considered safest for the client? 1. Ultrasonography 2. Nephrotomography 3. Excretory urography 4. Computed tomography

Rationale: 1 An ultrasound is the safest test to have done because it is noninvasive, affording minimal risk to the client. All of the other tests are invasive and involve injection of a contrast medium into the client's vein that can lead to an unexpected reaction or kidney injury.

A health care provider is about to perform a paracentesis for a client with abdominal ascites. The nurse assisting with the procedure should help the client into which position? 1. Supine 2. Upright 3. Right side-lying 4. Left side-lying

Rationale: 2 An upright position allows the intestine to float posteriorly and helps prevent intestinal laceration during catheter insertion. The client ideally sits upright in a chair, with the feet flat on the floor and with the bladder emptied before the procedure. Therefore, the remaining positions are incorrect.

The nurse is explaining to an older client about a creatinine clearance test that has been prescribed. What response by the client indicates that there is a need for further teaching? 1. "This test measures the levels of all of the medications that I take." 2. "With aging, the kidneys don't clear all of my medications, so I can get very ill." 3. "In older clients, changes in the renal system lead to less blood flow to the kidneys." 4. "The health care provider has to do studies on my kidneys to see how they are filtering."

Rationale: 1 A creatinine clearance test does not measure levels of a client's medications but measures the glomerular filtration rate of the kidneys and how effectively the kidneys can eliminate substances. The other options are accurate statements.

The nurse is caring for a client who has been diagnosed as having an acute kidney injury. What diagnostic test is most effective in confirming this diagnosis? 1. Renal biopsy 2. Ultrasonography 3. Computed tomography scan 4. Magnetic resonance imaging

Rationale: 1 A renal biopsy is considered the best method for confirming intrarenal causes of acute kidney injury (AKI). Magnetic resonance imaging (MRI) and computed tomography (CT) scans contain contrast mediums that can be harmful to clients. An ultrasound study is not definitive and may not provide enough information.

The nurse is scheduling diagnostic tests for a client. Which of the diagnostic tests prescribed should be performed last? 1. Barium enema 2. Barium swallow 3. Gallbladder series 4. Oral cholecystogram

Rationale: 2 A barium swallow should be done after a barium enema or gallbladder series to prevent the contrast used in the barium swallow from obstructing the view of other organs. It takes several days for swallowed barium to pass completely out of the gastrointestinal tract.

The nurse is developing a plan of care for a client who is scheduled to return to the nursing unit after a liver biopsy. What is the appropriate position for the client? 1. Prone 2. Supine 3. On the left side 4. On the right side

Rationale: 4 After a liver biopsy, the client is positioned on the right side with support under the costal margin to provide pressure. The remaining options are incorrect positions after a liver biopsy.

The nurse is assisting the health care provider in performing a lumbar puncture on a client. The nurse prepares the client for the procedure by placing the client in which position? 1. Fetal 2. Prone 3. Supine 4. Lateral

Rationale: 1 The client is assisted into a fetal position at the edge of the bed with the knees drawn up to the chest. This position allows full flexion of the spine and wider spaces between the vertebrae. The nurse also would place a pillow between the client's legs to prevent the upper leg from rolling forward and a small pillow under the client's head to support the spine in a horizontal position.

A client recovering from cardiac surgery has a left pleural effusion and is about to undergo a thoracentesis. What position should the nurse place the client in for the procedure? 1. Dorsal recumbent 2. Left lateral, with the right arm supported by a pillow 3. Right side-lying, with the legs curled up into a fetal position 4. Upright and leaning forward with the arms on an over-the-bed table

Rationale: 4 The client undergoing thoracentesis usually sits in an upright position with the anterior thorax supported by pillows or leaning over an over-the-bed table. The client must be placed in a position that will enlist the aid of gravity in accessing and draining the effusion. The dorsal recumbent position is an inaccessible position. Any side-lying position will cause fluid to accumulate under that side, which is inaccessible to the health care provider. However, if the client cannot sit upright, the client will be placed in a side-lying position on the unaffected side, with the side to be tapped uppermost.

The nurse is told to draw an arterial blood gas sample with the client on ambient air. The nurse documents in the record that the client was receiving how much oxygen for this procedure? 1. 16% 2. 21% 3. 30% 4. 40%

Rationale: 2 Ambient air is the same thing as room air, which contains 21% oxygen. It is not possible to give a client 16% oxygen because it is less than room air. The remaining options of 30% and 40% contain oxygen amounts that are commonly used to supplement oxygen for clients having respiratory difficulty.

Following myelography, how should the nurse plan to best position the client? 1. On the left side 2. On the right side 3. Head slightly elevated 4. Head lower than the rest of the body

Rationale: 3 A myelogram uses x-rays and contrast material to view the bones and the fluid-filled space (subarachnoid space) between the bones in the spine. It may be done to diagnose the presence of a tumor, an infection, problems with the spine such as a herniated disc, or narrowing of the spinal canal caused by arthritis. The head should be slightly elevated to prevent complications such as leaking of cerebrospinal fluid.

The nurse is teaching a client about what to expect during a gallium scan. The nurse should include which item as part of the instructions? 1. The procedure is noninvasive. 2. The client must stand erect during the filming. 3. The procedure takes about 30 to 60 minutes to perform. 4. The client should remain on bed rest for the remainder of the day after the scan.

Rationale: 3 A gallium scan requires the injection of gallium isotope 2 to 3 hours before the procedure; therefore, the procedure is invasive. The procedure takes 30 to 60 minutes to perform. The client will lie down during the procedure and must lie still. There is no special aftercare.

The nurse is caring for a client who is going to have arthrography with a contrast medium. Which assessment by the nurse would be of highest priority? 1. Allergy to iodine or shellfish 2. Whether the client wishes to void before the procedure 3. Ability of the client to remain still during the procedure 4. Whether the client has any remaining questions about the procedure

Rationale: 1 Because of the risk of allergy to contrast dye, the nurse places highest priority on assessing whether the client has an allergy to iodine or shellfish. The nurse also reinforces information about the test, assists the client to void before the procedure, and tells the client about the need to remain still during the procedure.

The clinic nurse has provided instructions to a client who will be reporting to the laboratory the next morning to have blood drawn for a complete blood cell count. Which statement made by the client indicates an understanding of the preparation for this laboratory test? 1. "There is no special preparation for this test." 2. "I cannot eat or drink anything after midnight." 3. "I need to avoid any cold cuts and luncheon meats for the rest of the day." 4. "I can drink coffee or tea in the morning before the test but cannot eat anything."

Rationale: 1 For most hematological laboratory studies, including complete blood cell count, no special care is needed either before or after the test. There is no reason to fast after midnight or avoid luncheon meats or cold cuts before the laboratory test being drawn.

The nurse explains to a client why telemonitoring is needed. What response by the client indicates a need for further instruction? 1. "Telemonitoring ignores artifact." 2. "These systems are not fail-proof." 3. "Monitoring helps to diagnose dysrhythmias, ischemia, or infarction." 4. "Electrodes have to be replaced when the conductive gel has dried out."

Rationale: 1 Telemonitoring does not ignore artifact. In fact, accurate interpretation of heart rhythm is difficult when artifact is present. All of the other options are correct.

A clinic nurse is reviewing the record of a client with a suspected diagnosis of pernicious anemia. The nurse anticipates that which diagnostic test will be prescribed by the client's health care provider? 1. Schilling test 2. Clotting time 3. Bone marrow biopsy 4. White blood cell differential

Rationale: 1 The Schilling test is used to determine the cause of vitamin B12 deficiency, which leads to pernicious anemia. This test involves the use of a small oral dose of radioactive B12, followed by a large nonradioactive intramuscular (IM) dose. The IM dose helps flush the oral dose into the urine if it was absorbed. A 24-hour urine collection is performed to measure the amount of radioactivity in the urine. Clotting time and a white blood cell differential count are not significantly related to pernicious anemia and would not be helpful in determining the diagnosis. A bone marrow biopsy is indicated in a client suspected of having leukemia.

The nurse is assisting the health care provider during a colonoscopy procedure. The nurse helps the client to assume which position for the procedure? 1. Left Sims' 2. Lithotomy 3. Knee chest 4. Right Sims'

Rationale: 1 The client is placed in the left Sims' position for the procedure. This position uses the client's anatomy to the best advantage for introducing the colonoscope. The left Sims' position would also be used for giving the client an enema while lying down. Therefore, options 2, 3, and 4 are incorrect.

A clinic nurse is providing instructions to a female client regarding the procedure for collecting a midstream (clean-catch) urine specimen. What should the nurse instruct the client to do? 1.Begin the flow of urine and then collect the specimen. 2.Cleanse the perineum from back to front before collecting the specimen. 3.Collect the specimen in the evening before going to bed, and deliver it to the laboratory immediately the next morning. 4.Scrub the perineum with povidone-iodine solution in the evening and again in the morning before collecting the specimen.

Rationale: 1 The client should briefly delay collecting the sample until after starting the flow of urine. As part of the correct procedure, the client should cleanse the perineum from front to back with the antiseptic swabs that are packaged with the specimen kit to prevent contamination of the specimen. The specimen should be sent to the laboratory as soon as possible and not allowed to stand. Improper specimen handling can yield inaccurate test results. The client is not instructed to scrub the perineum with povidone-iodine solution in the evening and again in the morning before collecting the specimen. This action is unnecessary and can cause irritation.

A client is about to undergo a lumbar puncture (LP). Which position should the nurse tell the client will be used during the procedure? 1. Prone, with a pillow under the abdomen 2. Prone, in a slight Trendelenburg's position 3. Side-lying position, with a pillow under the lower back, hip, and knees 4. Side-lying position, with legs pulled up and head bent down onto the chest

Rationale: 4 The client undergoing LP is positioned lying on the side, with the legs pulled up to the abdomen and the head bent down onto the chest. This position helps to open the spaces between the vertebrae and allows for easier needle insertion by the health care provider. Each of the other options is incorrect.

A client with diabetes mellitus is scheduled for a fasting blood glucose level determination in the morning. The nurse tells the client not to eat or drink after midnight. When the client asks for further information about fluid and food intake, the nurse clarifies by stating that which would be acceptable to consume before the test? 1. Water 2. Tea without any sugar 3. Coffee without any milk 4. Clear liquids such as apple juice

Rationale: 1 A client who is scheduled for a fasting blood glucose level determination should not eat or drink anything except water after midnight. This is necessary to ensure accurate test results, which form the basis for adjustments or continuance of treatment. The remaining options are inaccurate because they contain either protein or glucose, which can alter the laboratory values, and the client should not consume these items before the test.

The nurse is explaining to a client what electroencephalography (EEG) involves. What response by the client indicates that further teaching is needed? 1. "This test is minimally invasive." 2. "There is no risk of electric shock." 3. "It can help diagnose and treat my seizures." 4. "Electrodes are placed on specific areas of my scalp."

Rationale: 1 An EEG is noninvasive, not minimally invasive. All of the other options are correct.

The nurse provides instructions to a client who is scheduled for an electroencephalogram. Which statement by the client indicates a need for further instruction? 1. "The test will take between 45 minutes and 2 hours." 2. "My hair should be washed the evening before the test." 3. "Cola, tea, and coffee are restricted on the day of the test." 4. "All medications need to be withheld on the day of the test."

Rationale: 4 The client is informed that the test will take 45 minutes to 2 hours and that medications usually are not withheld before the test unless specifically prescribed. Preprocedural instructions include informing the client that the procedure is painless. Cola, tea, and coffee are stimulants and need to be restricted on the morning of the test. The hair should be washed the evening before the test, and gels, hair sprays, and lotion should be avoided.