Chapter 34: Diagnostic Testing

The nurse is caring for a woman who has a cyst in her breast that was found at her recent mammogram. The physician wants to make sure that the cyst is not malignant. Which test will be used to determine this? a. Needle aspiration with biopsy b. Paracentesis c. Thoracentesis d. Fiberoptic endoscopy

ANS: A Needle aspirations are procedures that are used to remove fluid and tissue for testing. A biopsy involves removing a larger collection of cells, as in a tumor or mass, and may be used to detect cancer in the skin, breast, or liver. Paracentesis is drainage of fluid from the abdomen, and thoracentesis is drainage of fluid from the pleural cavity. Fiberoptic endoscopy allows the physician to see inside the upper and/or lower GI tract.

The nurse is caring for a patient whose immune system is destroying red blood cells at a very rapid rate. Which test result will the nurse expect to see in the patient's chart as a result? a. Bilirubin level 4 mg/dL b. Platelet count 450,000/mm3 c. Serum uric acid level 1.7 mg/dL d. Partial thromboplastin time 45 seconds

ANS: A An elevated bilirubin level is the result of increased red blood cell destruction. Normal bilirubin levels are 0.3 to 1.0 mg/dL. Increased platelet count, decreased serum acid level, and decreased partial thromboplastin times are not indicative of increased red blood cell destruction.

The nurse is caring for a patient who is to have a noncontrast MRI scan performed. Which assessment finding leads the nurse to report that the patient may not be able to have the test? a. The patient has an implanted insulin pump. b. The patient is breastfeeding her newborn infant. c. The patient is severely allergic to iodine and latex. d. The patient has profound hearing loss.

ANS: A Any metal implants are a contraindication for an MRI scan because the scan uses powerful magnets. Insulin pumps often contain metal that can react with the strong magnets in the MRI machine. Breastfeeding is not a contraindication to MRI because there is no radiation exposure. No latex or iodine is used during MRI testing. Profound hearing loss will not be a problem, although MRI scanning is very loud.

The nurse is caring for a patient who has a deep leg wound that is badly infected. Which laboratory test results will the nurse expect to find in the patient's chart? a. Elevated C-reactive protein (CRP) 6.5 mg/dL b. Decreased serum creatinine 0.8 mg/dL c. Elevated serum bilirubin 0.5 mg/dL d. Prothrombin time (PT) 11.5 sec

ANS: A C-reactive protein (CRP) is produced by the liver in response to inflammation, tissue damage, and infection. Blood levels of CRP have been used as a marker for inflammatory and autoimmune disorders. The nurse would expect to see an elevated CRP in a patient with an infected wound. Creatinine is an indicator of kidney function, and bilirubin is an indicator of liver function. Prothrombin time indicates clotting ability of the blood, particularly when the patient is taking warfarin (Coumadin).

The nurse is caring for a patient who has had severe acid reflux. Which test will allow the physician to directly check for damage to the esophagus? a. Esophagogastroduodenoscopy (EGD) b. MRI scan with contrast c. Abdominal ultrasound d. Positron emission tomography (PET) scan

ANS: A EGD is performed using a lighted tube that allows for direct visualization of the esophagus, stomach, and upper duodenum. MRI, ultrasound, and PET scanning do not allow physicians to see the esophagus directly.

The nurse is caring for a patient who is scheduled for a needle aspiration and biopsy to rule out cancer. Which Nursing diagnosis is appropriate and important for this patient? a. Anxiety related to potential for cancer diagnosis depending on biopsy results b. Impaired health maintenance related to delayed insurance coverage for procedure c. Powerlessness related to lengthy wait for diagnosis d. Ineffective coping related to patient stated she is a little nervous about the test results

ANS: A Fear is an emotion commonly experienced by patients waiting for diagnostic tests and biopsy results. Impaired health maintenance related to delayed insurance coverage is not a priority diagnosis for this patient at this time. Powerlessness is about the patient's ability to control an outcome and is not related to the wait for test results. The patient statement of feeling a little nervous about the test results is not indicative of ineffective coping.

The nurse is caring for a patient who has diabetes. The patient reports compliance with the medical regime. Which test result indicates to the nurse that the patient has not been compliant with the treatment plan? a. Hemoglobin A1c 16% b. Random blood sugar (RBS) 112 mg/dL c. Lactate dehydrogenase (LDH) 55 units/L d. Erythrocyte sedimentation rate (ESR) 14 mm/hr

ANS: A Hemoglobin A1c (Hgb A1c), or glycosylated hemoglobin, testing evaluates blood sugar levels over a period of 2 to 3 months. This blood test is performed to provide the primary care provider (PCP) with information about long-term blood sugar control. The normal value of Hgb A1c in patients without diabetes is 4% to 5.9%. The American Diabetes Association (2016) states that diabetes is diagnosed for Hgb A1c levels greater than 6.5%. A higher level indicates that the patient has had poor blood glucose control during the past few weeks, and increases the patient's risk of long-term complications from hyperglycemia. The other tests are not related to long-term diabetes control.

The nurse is caring for a patient who will be undergoing bone marrow biopsy. Which statement by the patient indicates that additional teaching is needed? a. "I will count the ceiling tiles when the doctor inserts the numbing medicine." b. "I will take acetaminophen later today if the site becomes uncomfortable." c. "I will squeeze your hand to help calm my fears about the test." d. "I will keep the biopsy site clean and dry for the next 24 hours."

ANS: A The patient will be positioned in the prone or lateral position for the test, so the patient will not be able to count ceiling tiles as a distraction during the numbing step of the test. The patient may take acetaminophen as needed for discomfort afterward. The biopsy site must be kept clean and dry for 24 hours after the biopsy to prevent infection. Holding the nurse's hand will help calm the patient before and during the procedure.

The nurse is caring for a patient who will be undergoing flexible sigmoidoscopy testing to screen for colon cancer. What goal will the nurse include in the patient's plan of care? a. Patient will verbalize understanding of preprocedure preparation to be completed at home the day before the test. b. Patient will feel comfortable about the upcoming test and have trust in the health care providers. c. Patient will learn common side effects of the medications used to prepare the GI tract for endoscopy testing. d. Patient will realize how important regular sigmoidoscopy testing is in the prevention of colon cancer.

ANS: A The patient will need to complete colon preparation prior to the sigmoidoscopy testing. The nurse must determine that the patient understands how and when to complete the prep. Having the patient verbalize understanding of the prep procedure is an objective goal so that the nurse can readily determine whether or not it has been met. The other goals are not objective or measurable, so the nurse cannot determine whether or not they have been met.

The nurse is caring for a patient who is taking medication that is toxic to the liver. Which laboratory test results will be reviewed by the nurse to ensure that the patient's liver is tolerating the medication without damage to the organ? (Select all that apply.) a. Alanine aminotransferase (ALT) b. Alkaline phosphatase (ALP) c. Blood urea nitrogen (BUN) d. Anti-nuclear antibody (ANA) e. Erythrocyte sedimentation rate (ESR) f. Fibrin degradation products (FDP)

ANS: A, B Alanine aminotransferase (ALT) and alkaline phosphatase (ALP) are indicators of liver function, and increased levels indicate liver damage from a variety of causes. BUN, ANA, ESR, and FDP are not indicators of liver function.

The nurse is caring for a patient who is undergoing a liver biopsy. Which interventions will be included in the patient's care plan for the diagnosis of risk for infection: r/t invasive diagnostic procedure? (Select all that apply.) a. Monitor for and report redness, warmth, discharge, or fever promptly to the physician. b. Carefully maintain the sterile field during the biopsy procedure. c. Teach patient how to care for the biopsy site when procedure is completed. d. Provide a supportive, caring presence to minimize patient anxiety. e. Provide information about the pathophysiology and treatment options for liver cancer. f. Consider using healing touch and other mind-body-spirit interventions.

ANS: A, B, C Interventions for the Nursing diagnosis of risk for infection involve monitoring for signs and symptoms of infection, preventing contamination of supplies by maintaining a sterile field during the procedure, and teaching the patient how to care for the site afterward. Providing a caring presence, providing information about liver cancer, and using healing touch may be helpful for the patient but will not minimize the risk of infection.

The nurse is caring for a patient with a urinary tract infection. Which test will indicate which antibiotics will be effective to treat the infection? a. Complete blood count (CBC) b. Culture and sensitivity (C&S) c. Renal scan and angiography d. Radioreceptor assay for HCG

ANS: B Culture and sensitivity are performed on specimens to determine which bacteria are causing the infection and which antibiotics will be effective treatment. CBC, renal scan, and radioreceptor assay for HCG will not indicate which antibiotics may be used to treat an infection.

The nurse is caring for a patient who is anemic. Which CBC test results demonstrate that the patient's treatment plan is effective and the anemia is resolving? (Select all that apply.) a. Red blood cell count (RBC) 5.8 million/mm3 b. Hematocrit (HCT) 25% c. Hemoglobin (HGB) 14 g/dL d. White blood cell count (WBC) 4500/mm3 e. Platelet count (PLT) 255,000/mm3

ANS: A, C Red blood cell count of 5.8 million and hemoglobin value of 14 g/dL are both normal. Hematocrit level of 25% is very low and indicative of ongoing anemia. White blood cell and platelet counts are not checked for anemia.

The nurse is caring for a patient who has been having abdominal pain. The doctor suspects that the patient may have an abdominal aortic aneurysm. Which tests would confirm the doctor's suspicion? (Select all that apply.) a. Magnetic resonance imaging (MRI) scan b. Needle aspiration with biopsy c. Fiberoptic endoscopy d. Computed tomography (CT) scan e. Flexible sigmoidoscopy f. Thoracentesis

ANS: A, D CT scan and MRI may be used to determine the presence of an abdominal aortic aneurysm. Endoscopy, needle aspiration, sigmoidoscopy, and thoracentesis will not help make this diagnosis.

The nurse is caring for a patient who needs to collect a 24-hour urine specimen at home. Which steps of specimen collection may be delegated to the assistant? (Select all that apply.) a. Label the urine container and lab slips with the patient's name and information. b. Assess the patient's ability to collect the specimen as required. c. Explain the procedure to the patient. d. Obtain the urine container from the utility room or laboratory. e. Transport the specimen to the laboratory once it is collected. f. Ensure that the correct test is ordered and collected.

ANS: A, D, E The assistant may label the container and lab slips, obtain the urine container from the utility room, and transport the specimen to the lab. These are tasks that do not require nursing judgment. Assessment of the patient is always done by the nurse, as well as explaining the procedure to the patient and ensuring that the correct test is performed.

The nurse is caring for a patient who recently had a liver biopsy. To whom must the nurse give the results? a. The patient b. The patient's health care provider c. The patient's insurance provider d. The patient's spouse

ANS: B HIPAA protects the patient by requiring that testing results be shared only with health care professionals who need the information to provide treatment and with individuals designated in writing by the patient. The patient's provider will need the biopsy results to determine the patient's plan of care. The nurse does not give test results to the insurance company. The nurse may share the results with the patient or spouse, but it is not required, unless designated by the patient in writing.

The nurse is caring for a patient with diabetes who will be doing fingerstick blood glucose testing at home. What is the best way for the nurse to ensure that the patient can perform the procedure correctly? a. Quiz the patient on the steps of the procedure. b. Have the patient perform the procedure in front of the nurse. c. Ask the patient if he has any questions about the test. d. Use terminology that the patient can easily understand.

ANS: B Having the patient successfully perform the procedure in front of the nurse is an excellent way for the nurse to ensure that the patient knows how to do it correctly. Quizzing the patient about the procedure, asking the patient if he/she has questions, and using understandable terminology are fine, but only a return demonstration will assess the patient's ability to perform the procedure successfully and correctly.

The nurse is caring for a patient who has just undergone bronchoscopy. The patient requests a drink of water. What is the nurse's best action? a. Provide ice chips. b. Check the patient for a gag reflex. c. Provide a small cup of ice water with a straw. d. Keep the patient NPO.

ANS: B Numbing medication is applied to the back of the throat just before bronchoscopy. This may lead to swallowing difficulty and risk for aspiration until the gag reflex returns. The nurse should keep patient NPO until swallow, gag, and cough reflexes have returned. The nurse does not need to keep the patient NPO after the gag reflex returns so it should be checked in order to allow the patient to have fluids as soon as possible to relieve thirst.

The nurse is caring for a patient who is sedated following a colonoscopy. Which is the priority action of the nurse? a. Provide a quiet, dark environment so that the patient can rest comfortably. b. Monitor the patient's pulse oximetry and respirations closely. c. Inform the patient that the procedure has been completed. d. Assess the patient's bowel sounds and passage of flatus.

ANS: B The priority intervention for sedated patients is to monitor pulse oximetry and respirations closely because sedation may suppress the respiratory drive. The nurse should monitor vital signs until the patient is fully awake and observe stools for visible blood. The nurse should also instruct the patient to report any abdominal pain as these assessment findings are alerts for possible perforation of bowel, hypotension, and hemorrhage. Providing a quiet environment is nice for the patient, but dim lighting may impair the nurse's ability to assess the patient. Informing the patient that the procedure has been completed is not a priority. Assessing the patient's bowel sounds and passage of flatus is not as important as careful respiratory monitoring.

The nurse is caring for a patient who has a bleeding gastric ulcer. How will the nurse expect the patient's stool to appear? a. Soft and formed with bright red streaks b. Watery with particles of undigested food c. Sticky and black d. Hard lumps that are difficult to pass

ANS: C Bleeding anywhere along the GI tract results in blood in the stool. Bleeding that occurs in the upper GI tract produces stools that are black and tarry in appearance. Bleeding within the lower GI tract presents with soft stools that have bright red streaks. Watery stool with particles of food is indicative of gastroenteritis. Hard lumps that are difficult to pass indicate constipation, often from medications or lack of fiber in the diet.

The nurse is caring for a patient who is having blood drawn as part of preoperative testing. Which step is the most important to ensure the safety of the patient and the nurse? a. Ensuring that the tourniquet is not left in place for too long b. Using the smallest possible needle for venipuncture c. Properly disposing of the needle after the specimen is obtained d. Making sure that all of the collection tubes are filled completely

ANS: C Proper disposal of needles and sharps after procedures is essential for safe nursing practice to ensure the safety of staff as well as patients. Ensuring that the tourniquet is not left on too long, using the smallest needle possible, and making sure that all of the vials are filled are important steps in venipuncture, but only proper sharps disposal will help ensure the safety of the patient and the nurse.

The nurse is caring for an elderly patient with dementia. Which laboratory finding indicates to the nurse that that patient is often forgetting to eat meals? a. Serum bilirubin 0.4 mg/dL b. PLT (platelet count) 425,000/mm3 c. Serum cholesterol 175 mg/dL d. Albumin 1.4 g/dL

ANS: D Albumin level is an indicator of the patient's protein intake and nutritional status. Normal albumin level is 3.3 to 5 g/dL. It is an essential component of fluid balance, responsible for maintaining colloidal oncotic pressure in the vascular and extravascular spaces. Low levels of albumin may indicate malnutrition.

The nurse is caring for a patient who is to collect a 24-hour urine specimen. Which statement by the patient indicates that additional teaching is required? a. "I will keep the urine container on ice to keep it chilled until I bring it to the lab." b. "I will start the test over if I forget and urinate into the toilet during the testing time." c. "I will start the test tomorrow after I urinate first thing in the morning." d. "I will drink extra fluids so that the lab will have a large specimen to test."

ANS: D Drinking extra fluids so that the lab will have an extra-large specimen to test is not done as part of 24-hour urine collection, and it may skew the test results. The specimen should be kept chilled on ice or in a refrigerator until it is brought to the lab. If the patient accidentally urinates in the toilet, the test must be started over again. Urine collection is started after the patient's first void of the morning into the toilet.

The nurse is caring for a patient who will be receiving iodine-based contrast medium for a CT scan. Which allergy should be reported to the technician and radiologist before the test is performed? a. Gluten and lactose b. Strawberries and blueberries c. Peanuts and cashews d. Shrimp and scallops

ANS: D If the patient is undergoing an examination that involves an iodine contrast medium, check for a history of adverse reactions or allergies to iodine-containing food (e.g., shellfish, cabbage, kale, iodized salt). The other allergies are not related.

The nurse is caring for a patient who has just undergone paracentesis. For which complication will the nurse carefully monitor? a. Collapse of the lung with shortness of breath b. Fecal impaction from retained barium in the colon c. Cerebrospinal fluid leak resulting in severe headache d. Perforation of the bowel resulting in abdominal infection

ANS: D Paracentesis is drainage of fluid from the abdominal cavity. Since the needle is near the intestines, bowel perforation can occur, manifested by abdominal pain and fever as infection (peritonitis) sets in. Possible complications do not include lung collapse, CSF leak, or impaction.