Fundamentals Term 4 Laboratory tests

The nurse is assisting in the care of a client for whom an arterial blood gas (ABG) must be drawn. The nurse notes that the person who draws the blood sample from the radial artery performs an Allen's test first. The nurse recognizes that this is being done to determine the adequacy of which circulations? Select all that apply.

- Ulnar circulation - Radial circulation

The nurse is preparing a client scheduled for a bone marrow aspiration, and the client asks the nurse whether the procedure will be painful. The nurse should make which response to the client?

"A local anesthetic will be given and will decrease the discomfort."

A primary health care provider prescribes a 24-hour urine collection for vanillylmandelic acid (VMA). The nurse instructs the client in the procedure for the collection of the urine. Which statement by the client would indicate a need for further teaching?

"I can take any medications if I need to before the collection."

A client undergoing diagnostic testing for cancer is scheduled for magnetic resonance imaging (MRI). The nurse reinforces to the client which information about the procedure?

Expect the MRI machine to make loud noises.

A client is scheduled for an oral cholecystography. The nurse should plan to obtain what type of diet for the evening meal before the test?

Fat-free Rationale: Normal dietary intake of fat should be maintained during the days preceding the test in order to empty bile from the gallbladder. A fat-free diet is prescribed on the evening before the test. The fat-free supper prevents contraction of the gallbladder and allows accumulation of the contrast substance needed for x-ray visualization.

The nurse is preparing to care for a client following a lumbar puncture. The nurse plans to place the client in which position immediately after the procedure?

Prone with a pillow under the abdomen Rationale: For 1 hour after the procedure, the client assumes a prone position if able with a pillow under the abdomen to increase intra-abdominal pressure. This position retards leakage of cerebrospinal fluid. Prone in semi-Fowler's position, supine with a pillow under the head, and lateral with the head slightly higher than the rest of the body are not the correct positions after a lumbar puncture.

The nurse is reinforcing instructions to a female client regarding the procedure for collecting a midstream urine sample. Which statement by the client indicates an understanding of the procedure?

"I need to collect the urine in the cup after I start to urinate."

The client has just undergone computed tomography (CT) scanning with a contrast medium. Which statement by the client demonstrates an understanding of postprocedure care?

"I should drink extra fluids for the remainder of the day." Rationale: After CT scanning, the client may resume all usual activities. The client should be encouraged to take in extra fluids to replace those lost with diuresis from the contrast dye.

The nurse is caring for the client who is going to have an arthrogram using a contrast medium. Which data collected by the nurse should be of highest priority?

Allergy to iodine or shellfish

A client has had a bone scan procedure. The nurse determines that the client understands the elements of follow-up care if the client states which postprocedural care?

Drink plenty of water for a day or two following the procedure. Rationale: There are no special restrictions following a bone scan. The client is encouraged to drink large amounts of water for 24 to 48 hours to flush the radioisotope from the system. The minimal amount of radioactivity of the isotope poses no hazards to the client or staff.

A client suspected of having an abdominal tumor is scheduled for a computed tomography (CT) scan with dye injection. The nurse should tell the client which information about the test?

The dye injected may cause a warm, flushing sensation.

The nurse reinforces postoperative liver biopsy instructions to a client. Which should the nurse tell the client?

Lie on the right side for 2 hours. Rationale: To splint the puncture site, the client is kept on the right side for a minimum of 2 hours.

The nurse is reinforcing preprocedure instructions to a client scheduled for a barium swallow at 8.00 am. Which statement by the client indicates a need for further teaching?

I will limit myself to two cigarettes only on the morning of the test.

The nurse reinforces instructions to a client who is to return to the primary health care provider's office in 1 week for a patch test to identify the allergen causing the dermatitis. The nurse provides which instruction to the client?

"Discontinue the prescribed antihistamine 2 days before the test." Rationale: Client preparation for a patch test includes informing the client to discontinue systemic corticosteroids or antihistamines for at least 48 hours before the test. To prevent suppression of the inflammatory response to an allergen, these medications must be discontinued. A client does not need to be NPO, may consume fluids, and may take a shower with antibacterial soap before a patch test.

A client being seen in a primary health care provider's office has just been scheduled for a barium swallow the next day. The nurse writes down which instructions for the client to follow before the test?

"Do not eat or drink after midnight tonight." Rationale: A barium swallow is an x-ray that uses a substance called barium for contrast to highlight abnormalities in the gastrointestinal (GI) tract. The client should not eat or drink after midnight. The client swallows the barium to outline the esophagus and stomach. No scope is involved in this procedure.

The nurse is planning to administer an oral glucose tolerance test (OGTT) to a client to rule out or confirm diabetes mellitus. The nurse knows that the client needs more information when the client makes which statements? Select all that apply.

"I can at least drink fluids during the test." "I have 30 minutes to drink the glucose load." "I will have blood drawn every 5 minutes for the next 3 hours."

Which statement by the client should cause the nurse to suspect that the thyroid test results drawn on the client this morning may be inaccurate?

"I had a radionuclide test done 3 days ago." Rationale: Recent radionuclide scans performed before the test can affect thyroid laboratory results. There are no food, fluid, or activity restrictions required for this test.

The nurse has reinforced instructions to a client about an upcoming endoscopic retrograde cholangiopancreatography (ERCP) procedure. The nurse determines that there is a need for further teaching if the client makes which statement?

"I hope the incision from the test will heal quickly."

The nurse has provided instructions to a client scheduled for a mammography regarding the procedure. Which statement by the client indicates an understanding of the procedure?

"I should not wear deodorant on the day of the test." Rationale: Mammography takes about 15 to 30 minutes to complete. Some discomfort may be experienced because of the breast compression required to obtain a clear image.

A client who has undergone barium enema is being readied for discharge. The nurse determines that the client has understood discharge instructions when the client makes which statement?

"I will be sure the barium passes and watch for my stools to return to normal." Rationale: Discharge teaching following this procedure includes instruction that the client should watch for the barium to pass and then for regular stool passage to resume. Stools change from clay-colored back to a normal color.

The nurse informs a client that a Papanicolaou smear will be done at the next scheduled clinic visit, and the nurse provides instructions to the client regarding preparation for this test. Which statement by the client indicates an understanding of the procedure?

"If I have my period at the time of my next scheduled visit, I will not be able to have the test done." Rationale: A Papanicolaou smear cannot be performed during menstruation. The test is usually painless. The client needs to be instructed to avoid douching for at least 24 hours before the test.

Abdominal ultrasonography is prescribed for a client who is pregnant. The nurse provides information to the client regarding the procedure and makes which statement?

"You will be positioned on your back and turned slightly to one side with your head elevated."

The nurse has just confirmed that a client has been scheduled for a mammogram for the following week. The nurse reinforces that the client should take which actions? Select all that apply.

- Avoid applying skin lotion on the day of the test. - Remove any necklaces before presenting for the procedure.

The nurse is preparing a client for the administration of a tuberculin skin test. The nurse determines that which body areas are appropriate for intradermal injections? Select all that apply.

- Inner aspect of the forearm - Dorsal aspect of the upper arm - Away from heavy pigmentation

A client is scheduled for a myelogram, and the nurse reinforces a list of instructions to the client regarding preparation for the procedure. Which instructions should the nurse include in the list? Select all that apply.

- Jewelry will need to be removed. - An informed consent will need to be signed. - Nonalcoholic fluid intake should be increased after the procedure. Rationale: A myelogram is a diagnostic test that consists of contrast media being injected into the subarachnoid space to determine any pathology of the spine and vertebral column. The client will need to remove jewelry and metal objects from the chest area. An informed consent is required because the procedure is invasive and is therefore performed by the primary health care provider. Increased intake of nonalcoholic fluids is encouraged afterward to prevent any headache after the procedure. A health care professional such as a radiologist, neurologist, or specialized nurse practitioner will perform the test. Client preparation for a myelogram includes instructing the client to restrict food and fluids for 4 to 8 hours before the procedure. The client is told that the procedure takes about 45 minutes.

A pulmonary angiography is scheduled for a client suspected of having a pulmonary embolism. The nurse understands that which actions are an appropriate preprocedure care intervention? Select all that apply.

- Obtain a signed informed consent form. - Prepare the anticipated entry site for local anesthesia. - Inquire whether the client has any allergies to shellfish. - Ask whether client has ever experienced an allergy to any contrast media.

Several laboratory tests are prescribed for a client, and the nurse reviews the results of the tests. Which laboratory test results should the nurse report? Select all that apply.

- Platelets 35,000 mm3 (35 × 109/L) - Sodium 150 mEq/L (150 mmol/L) - Segmented neutrophils 40% (0.40) - White blood cells, 3000 mm3 (3.0 × 109/L) Rationale: The normal values include the following: platelets 150,000 mm3 to 400,000 mm3 (150-400 × 109/L); sodium 135 mEq/L to 145 mEq/L (135-145 mmol/L); potassium, 3.5 mEq/L to 5.0 mEq/L (3.5-5.0 mmol/L); segmented neutrophils 60% to 70% (0.60-0.70); serum creatinine, 0.6 mg/dL to 1.3 mg/dL (53-115 mcmol/L); and white blood cells 5000 mm3 to 10,000 mm3 (5.0-10.0 × 109/L). The platelet level noted is low; the sodium level noted is high; the potassium level noted is normal; the segmented neutrophil level noted is low; the serum creatinine level noted is normal; and the white blood cell level is low

The nurse prepares a client for the lumbar puncture procedure by which interventions? Select all that apply.

- Review the coagulation laboratory studies. - Observe the lower lumbar area for skin infections. - Check to see the client has a signed consent for the procedure. Rationale: A lumbar puncture is usually done for diagnostic purposes. The nurse should observe the lumbar area for skin irritation or infection since this will delay the procedure. The skin infection could be a source for a severe infection in the nervous system. The nurse should review the client's coagulation laboratory studies.

The nurse is providing a list of instructions to a client who is scheduled to have an electroencephalogram (EEG). Which instructions should the nurse place on the list? Select all that apply.

- Tea and coffee are restricted on the day of the test. - The test will take between 45 minutes and 2 hours. - The hair should be washed the evening before the test. Rationale: Preprocedure instructions include informing the client that the procedure is painless. The procedure requires no dietary restrictions other than avoidance of cola, tea, and coffee on the morning of the test. These products have a stimulating effect and should be avoided. The hair should be washed the evening before the test, and gels, hairsprays, and lotion should be avoided. Any hair decorations should be removed. The client is informed that the test will take 45 minutes to 2 hours and that medications are usually not withheld before the test.

The nurse is assigned to care for a client who has just returned to the nursing unit following a renal biopsy. The nurse plans to do which actions to properly care for this client for the remainder of the shift? Select all that apply.

- Test the urine for occult blood. - Observing the urine and biopsy site for bleeding. Rationale:Following renal biopsy, serial urine samples are tested for occult blood. The urine should be observed for frank hematuria and the biopsy site for edema and bleeding. Fluids are encouraged to flush the kidney. Opioid analgesics are often used to manage the renal colic pain that some clients feel after this procedure.

The nurse is completing the laboratory requisition that will accompany an arterial blood gas (ABG) specimen sent to the laboratory for analysis. The nurse understands that which data will be needed by the laboratory for adequate evaluation of the specimen? Select all that apply.

- The client's temperature -The date the specimen was drawn - The time the specimen was drawn - Any supplemental oxygen the client is receiving

The nurse is observing a nursing student preparing to obtain a throat culture on a client suspected of having a beta-hemolytic Streptococcus infection. Which actions indicate the need for further teaching regarding collecting this specimen? Select all that apply.

- The student asks the client to tilt the head forward and to open the mouth. - The student places the collection swab initially at the back of the client's tongue.

A 24-hour urine specimen for creatinine and electrolytes has been prescribed for a hospitalized client to evaluate kidney function. The nurse explains the procedure to the client. The client voids at 0900, and the urine is discarded. The client voids at 1200 and the urine is measured and placed in the collection container. At which time the next day should the 24-hour urine collection be complete? Fill in the blank with the correct military time.

0900 Rationale: The urine collection should be complete by 0900 the next day when a full 24 hours of urine produced by the client will have been collected. The purpose of the urine collection is to measure the total amount of creatinine and electrolytes excreted in the urine over a 24-hour period.

The nurse is reinforcing postprocedure teaching after a client underwent an upper gastrointestinal (GI) series. The nurse reminds the client that the stools will remain white for approximately how long?

1 to 2 days Rationale: It takes at least 12 to 24 hours and possibly up to 3 days for a substance to pass through the colon.

A client has been admitted to the hospital for urinary tract infection and dehydration. The nurse determines that the client has received adequate volume replacement if the blood urea nitrogen level drops to which value?

15 mg/dL (5.25 mmol/L) Rationale: The normal blood urea nitrogen level is 6 mg/dL to 20 mg/dL (2.1-7.1 mmol/L). Values of 29 mg/dL mg/dL (10.15 mmol/L) and 35 mg/dL (12.25 mmol/L) reflect continued dehydration.

The nurse is caring for a client with a diagnosis of cancer who is immunosuppressed. The nurse would suggest to the registered nurse the need for implementing neutropenic precautions if the client's white blood cell count was which value?

2000 mm3 (2.0 × 109/L) Rationale: The normal white blood cell count ranges from 5000 mm3 to 10,000 mm3 (5-10 × 109/L). The client who has a decrease in the number of circulating white blood cells is immunosuppressed.

A client with diabetes mellitus has a blood sample drawn for the determination of a fasting blood glucose level. When reviewing the client's results, the nurse determines that which requires a call to the primary health care provider for intervention?

240 mg/dL (13.7 mmol/L) Rationale: The normal fasting blood glucose level is 70 mg/dL to 100 mg/dL (4-6 mmol/L) in the adult client. Values above the normal range should be evaluated to determine whether further intervention is needed. The most critical value is 240 mg/dL (13.7 mmol/L).

A client with a history of cardiac disease is due for a morning dose of furosemide. Which serum potassium level, if noted in the client's laboratory report, should be reported before administering the dose of furosemide?

3.2 mEq/L (3.2 mmol/L) Rationale: The normal serum potassium level in the adult is 3.5 mEq/L to 5.0 mEq/L (3.5-5.0 mmol/L).

A client is to have an upper gastrointestinal (GI) series. Which nursing action should be done concerning the procedure?

Administer a laxative after the procedure because barium was administered. Rationale: Barium sulfate, which is used as contrast material during an upper GI series, is a constipating material. If it is not eliminated from the GI tract, it can cause obstruction. Therefore, laxatives or cathartics are administered as part of routine postprocedure care.

A client is scheduled for endoscopic retrograde cholangiopancreatography (ERCP). The nurse includes which intervention in the plan of care for the client?

After the procedure, keep the client nothing by mouth (NPO) until the gag reflex returns. Rationale: ERCP is often done to explore the common bile duct or pancreatic duct. ERCP requires that a client is NPO for 12 hours before the procedure. Because an endoscope is inserted through the oral cavity, the throat is sprayed with an anesthetic and the client will be kept NPO until the gag reflex returns.

The nurse is assisting in preparing a client for a cardiac catheterization. The nurse understands that it is important to check the client's record for which history?

Allergy to shellfish Rationale: Allergy to seafood, iodine, or iodine contrast media in the preprocedure period may necessitate a skin test for allergy severity and the use of prophylactic antihistamines to prevent an allergic response to the contrast medium.

A client has a prescription to receive purified protein derivative (PPD) 0.1 mL intradermally (tuberculin skin test). The nurse prepares to administer the PPD and obtains a tuberculin syringe with a 26-gauge, ⅝-inch needle. Which technique should the nurse use to insert the needle?

Almost parallel to the skin with bevel side up Rationale: A tuberculin skin test is administered by giving 0.1 mL of PPD intradermally. This involves drawing the medication into a tuberculin syringe with a 25- to 27-gauge, ⅝-inch needle. The injection is given by inserting the needle as close as possible to a parallel position with the skin and with the needle bevel facing up. This results in formation of a wheal, when administered correctly.

A tuberculin skin test is administered to an individual infected with human immunodeficiency virus (HIV). Seventy-two hours later, the nurse checks the test site and documents the results as positive, indicating that the individual has been exposed to tuberculosis. Which findings did the nurse identify to make this interpretation?

An area of induration at the test site measuring 7 mm Rationale: Normally, an area of induration greater than 15 mm is considered positive in low-risk individuals. However, an area of induration that measures 5 mm or greater in people with HIV infection is considered positive.

A lethargic, pale child is brought to the primary health care provider's office with symptoms of periorbital edema and reduced quantity of urine output. The urine is cloudy and smoky in color. The nurse asks the mother if the child has had any recent infections, to which the mother responds that the child had a very sore throat a few weeks ago. The primary health care provider suspects that the child might have acute poststreptococcal glomerulonephritis. Which laboratory test would rule out a past streptococcal infection in the child?

Antistreptolysin titer Rationale: Option 3 is the only laboratory test that will determine if a streptococcal infection was present. The other options do not relate to a past streptococcal infection.

The nurse is assisting in performing an arterial blood gas (ABG) analysis on a client. The nurse initially implements which intervention after the blood gas is drawn to minimize the risk for uncontrolled bleeding?

Applying direct pressure to the site Rationale: Pressure should be applied to the site following an ABG draw. The pressure in the artery is higher than in the veins. It is therefore necessary to apply pressure to the punctured artery to control bleeding usually for 5 minutes.

A client will undergo a barium swallow to confirm a diagnosis of a hiatal hernia. In preparation for the test, which instruction should the nurse provide the client?

Avoid eating or drinking after midnight before the test. Rationale: The stomach should be empty at the time of a barium swallow because food and medications can interfere with test results. Smoking increases mucous and acid production and can interfere with the test. For this reason, all foods, liquids, medication, and smoking are avoided before the test.

A client has just undergone endoscopy. Which is the essential postprocedure nursing intervention?

Check the gag reflex before giving oral foods or fluids. Rationale :During the endoscopy procedure, a scope is introduced through the mouth to visualize the esophagus, stomach, and some of the duodenum. The client is given a local anesthetic in the back of the throat and sedation during the procedure. The client may not eat or drink after this procedure until protective airway reflexes return in order to prevent aspiration. The nurse must document that the gag and swallow reflexes have returned.

A licensed practical nurse (LPN) is providing follow-up teaching after a client underwent an upper gastrointestinal (GI) series with diatrizoate used for contrast. The nurse instructs the client that which may occur from the diatrizoate?

Diarrhea Rationale: If diatrizoate is used for contrast, significant diarrhea is possible. It may also cause nausea and vomiting. Excessive flatus, abdominal pain, and gastrointestinal bleeding are not associated with diatrizoate administration.

A client scheduled for a pulmonary angiography is fearful about the procedure and asks the nurse if the procedure involves significant pain and radiation exposure. The nurse gives a response to the client that provides reassurance, based on which understanding?

Discomfort may occur with needle insertion, and there is minimal exposure to radiation. Rationale: Pulmonary angiography involves minimal exposure to radiation. The procedure is painless, although the client may feel discomfort with insertion of the needle for the catheter that is used for dye injection.

A client brought to the emergency department states that he has accidentally been taking two times his prescribed dose of warfarin for the past week. After noting that the client has no evidence of obvious bleeding, the nurse plans to assist the registered nurse with which action?

Drawing a sample for prothrombin time (PT) and international normalized ratio (INR) Rationale: The action that the nurse should take is to draw a sample for PT and INR level to determine the client's anticoagulation status and risk for bleeding. These results will provide information as to how to best treat this client (e.g., if an antidote such as vitamin K or a blood transfusion is needed). The aPTT monitors the effects of heparin therapy.

The nurse is caring for a client scheduled for magnetic resonance imaging (MRI). Which instruction does the nurse reinforce to the client?

Earplugs can be worn if the noise from the machine is uncomfortable.

The nurse reinforces what information to a client who is scheduled for an electromyogram (EMG)?

Electrodes will be inserted into the skeletal muscles. Rationale: An electromyogram involves insertion of needle electrodes into selected skeletal muscles to evaluate changes and electrical potential of the muscles and the nerves that lead to them. The test is useful in evaluating suspected lumbar or cervical disk disease, myasthenia gravis, muscular dystrophy, and other musculoskeletal diseases. The client should be reassured that the needle will not electrocute him or her, and that he or she will experience sensations comparable to an injection as the needles are inserted. An informed consent is required, and no other special preparation is required for this test.

The nurse is reviewing the serum electrolyte laboratory results of a client and finds that the client has an elevated magnesium level. Which part of the client's history is likely associated with this problem?

History of chronic laxative use Rationale: Magnesium is contained in many foods, but most cases of hypermagnesemia are not dietary related. Clients, who have problems with severe constipation, may abuse laxatives that contain magnesium such as magnesium hydroxide.

A client with atrial fibrillation who is receiving maintenance therapy of warfarin sodium has a prothrombin time (PT) of 35 seconds and an international normalized ratio (INR) of 3.5. On the basis of these laboratory values, the nurse anticipates which prescription?

Holding the next dose of warfarin Rationale: The normal PT is 11 seconds to 12.5 seconds (conventional therapy and SI units). The normal INR is 0.81 to 1.2 (conventional therapy and SI units); 2 to 3 for standard warfarin therapy, which is used for the treatment of atrial fibrillation, and 3 to 4.5 for high-dose warfarin therapy, which is used for clients with mechanical heart valves. A therapeutic PT level is 1.5 to 2 times higher than the normal level. Because the values of 35 seconds and 3.5 are high, the nurse should anticipate that the client would not receive further doses at this time.

A client is complaining about pain when voiding. The primary health care provider prescribes a clean-catch urine specimen. The nurse should instruct the client to perform which action first when obtaining this specimen?

Instruct the client to wash her hands. Rationale: The client will need detailed instructions about obtaining a clean-catch urine specimen because contamination will alter the results of the urinalysis and/or urine culture. Washing hands helps prevent bacteria from the hands contaminating the specimen and should be the first action in obtaining the specimen.

An adult female client has a hemoglobin level of 10.8 g/dL (108 g/L). The nurse interprets that this result is most likely caused by which condition noted in the client's history?

Iron deficiency anemia Rationale: The normal hemoglobin level for an adult female client is 12 g/dL to 16 g/dL (120-160 g/L). Iron deficiency anemia can result in lower hemoglobin levels. Dehydration may increase the hemoglobin level by hemoconcentration.

The nurse has reinforced postprocedure instructions to a client who has undergone a colonoscopy. The nurse determines that there is a need for further teaching if the client makes which statement?

It is all right to drive an hour after the test is finished. Rationale: The client should not drive for several hours after this test because the client would have received sedative medications during the procedure. The client should arrange in advance for someone to drive the client home. The client should resume intake slowly and progress as tolerated.

The nurse assists the primary health care provider in performing a lumbar puncture on a 3-year-old child with leukemia suspected of central nervous system (CNS) disease. In which position should the nurse place the child during this procedure?

Lateral recumbent with the knees flexed to the abdomen and head bent with the chin resting on the chest

A client is receiving a continuous intravenous infusion of heparin sodium to treat deep vein thrombosis. The client's activated partial thromboplastin (aPTT) time is 65 seconds. The licensed practical nurse reviews the laboratory results with the registered nurse, anticipating that which action is needed?

Leaving the rate of the heparin infusion as is Rationale: The normal aPTT varies between 28 seconds and 35 seconds, depending on the type of activator used in testing. The therapeutic dose of heparin for treatment of deep vein thrombosis is to keep the aPTT between 1.5 and 2.5 times normal. This means that the client's value should not be less than 40 seconds or greater than 87.5 seconds. Thus the client's aPTT is within the therapeutic range, and the dose should remain unchanged.

The nurse is reinforcing teaching to a client about an upcoming colonoscopy procedure. The nurse should include in the instructions that the client will be placed in which position for the procedure?

Left Sims' position

A client has just undergone a gastroscopy. Which action should be taken by the nurse as the essential postprocedure nursing intervention?

Monitoring for the gag reflex Rationale: To prevent aspiration, the client may not eat or drink after this procedure until protective airway reflexes return. The nurse must document that the gag and swallow reflexes have returned. The client would receive a local anesthetic to the throat before the procedure, not after.

A client with a tentative diagnosis of gastroesophageal reflux disease (GERD) is going to undergo ambulatory pH monitoring. The nurse assists in the procedure and should bring which item to the bedside?

Nasogastric (NG) tube

The clinic nurse reads the results of a tuberculin skin test performed on a 5-year-old child. The results indicate an area of induration measuring 8 mm. Which correct interpretation should the nurse make about these results?

Negative Rationale: Induration measuring 15 mm or greater is considered a positive result in a child 4 years or older who has no associated risk factors. Because this child's results show an area of induration measuring 8 mm, the finding is negative.

Which action should the nurse include in the plan of care for a client following a renal scan?

No special precautions are needed except to wear gloves if coming into contact with the client's urine. Rationale: No specific precautions follow a renal scan. The nurse wears gloves to maintain standard precautions.

A client with Crohn's disease is seen by the primary health care provider, and a complete blood count (CBC) has been prescribed. The nurse reinforces instructions to the client who will be reporting to the laboratory in the morning to have the blood test drawn. The nurse gives the client which information about this test?

No special preparation is necessary. Rationale: For most hematological laboratory studies, including a CBC, there is no special care needed either before or after the test.

A primary health care provider (PHCP) has written a prescription for a preoperative client to have "enemas until clear." The nurse has administered three enemas and the client is still passing brown liquid stool. Which action should the nurse take next?

Notify the primary health care provider. Rationale: Up to three enemas may be given when there is a prescription for enemas until clear. If more than three are necessary, the nurse notifies the PHCP (or act based on agency policy). Excessive enemas could cause fluid and electrolyte depletion.

A client who has been prescribed indomethacin for gout is asked to provide a stool sample for guaiac testing. The nurse explains that the purpose of the test is to make which determination?

Occult blood Rationale: Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID) medication that can cause gastrointestinal irritation. The stool guaiac test is noninvasive and is widely used as a gross screening for blood in the gastrointestinal tract. It is not used for any of the steatorrhea (fat in the stool), pH, or parasite infestation.

A gastric analysis is prescribed for a client with a suspected diagnosis of tuberculosis (TB). The nurse understands that the test is relevant in confirming this diagnosis because of which related fact?

People can frequently swallow small amounts of sputum. Rationale: Tuberculosis is confirmed by finding the organism Mycobacterium tuberculosis in sputum by microscopic examination. Gastric analysis is a test that aspirates stomach contents and examines them for many factors, the primary one being pH. Because many people cough and swallow rather than spit out their sputum, viewing stomach contents can be diagnostic. Mycobacterium tuberculosis is not spread through contaminated food.

A client with a history of gastrointestinal bleeding has a platelet count of 300,000 mm3 (300 × 109/L). The nurse should take which action after seeing the laboratory results?

Place the normal report in the client's medical record. Rationale: A normal platelet count ranges from 150,000 mm3 to 400,000 mm3 (150-400 × 109/L).The nurse should place the report containing the normal laboratory value in the client's medical record. A platelet count of 300,000 mm3 (300 × 109/L) is not an elevated count.

A client with diabetes mellitus has a glycosylated hemoglobin A1c level of 9%. On the basis of this test result, the nurse plans to reinforce teaching the client about the need for which measure?

Preventing and recognizing hyperglycemia Rationale: The normal reference range for the glycosylated hemoglobin A1c (HgbA1c) is 4.0% to 6.0%. This test measures the amount of glucose that has become permanently bound to the red blood cells from circulating glucose. Elevations in the blood glucose level will cause elevations in the amount of glycosylation. Thus the test is useful in identifying clients who have periods of hyperglycemia that are undetected in other ways.

A client is scheduled for a digital subtraction angiography (DSA). The nurse tells the client that the test is directed toward which outcome?

Providing information about the blood vessels Rationale: Digital subtraction angiography is a radiographic method to study the blood vessels. The nurse should explain to the client that the test gives instant information about the blood vessels.

A client has a prescription to have radial arterial blood gases (ABGs) drawn. Before drawing the sample, an Allen's test will be performed. In performing the Allen's test, which blood vessel(s) should the nurse occlude?

Radial and ulnar arteries, releases one, evaluates the color of the hand, and repeats the process with the other artery Rationale: Before drawing an ABG, the nurse checks the collateral circulation to the hand with the Allen's test. This involves compressing both the radial and ulnar arteries and asking the client to close and open the fist. This should cause the hand to become pale. The nurse then releases pressure on one artery and observes if circulation is quickly restored. The process is then repeated releasing the other artery. The blood sample may be safely taken if there is adequate collateral circulation

A clinic nurse has given a client the materials needed to test the stool for occult blood as part of a routine screening for colorectal cancer. When the client asks the nurse whether there are any special precautions that must be followed in doing this test, the nurse tells the client to avoid eating which food for at least a day before performing the test?

Red meat Rationale: The client should avoid eating red meat for at least 24 hours before obtaining the sample. This will help prevent false-positive results because red meat contains animal blood.

The nurse is preparing a client for a magnetic resonance imaging (MRI) examination. Which action by the nurse is important?

Remove metallic objects from the client.

The client is having a lumbar puncture (LP) performed. The nurse should place the client in which position for the procedure?

Side-lying, with legs pulled up and chin to the chest Rationale: This position helps to open the spaces between the vertebrae.

A client who has undergone a barium enema is being readied for discharge from the ambulatory care unit. Which instruction should the nurse include in instructions to the client?

The barium will cause the stools to be clay colored, but then the stool becomes normal colored.

The nurse is reinforcing instructions to a client who is to have a gallium scan about the procedure. The nurse should include which item as part of the instructions?

The gallium will be injected intravenously 2 to 3 hours before the procedure. Rationale: A gallium scan is similar to a bone scan, but with an injection of gallium isotope instead of technetium-99m (99mTc). Gallium is injected 2 to 3 hours before the procedure, which takes 30 to 60 minutes to perform.

A bone marrow aspiration is scheduled for a client suspected of having leukemia. What intervention does the nurse anticipate will be done to protect the aspiration site and client from becoming infected?

The site will be cleansed thoroughly with an antiseptic and allowed to air dry before the procedure. Rationale: A bone marrow aspiration is done on a client suspected of having leukemia to establish the diagnosis and the specific type. The bone marrow is taken from the sternum or iliac crest. Before bone marrow aspiration, the site is cleansed with an antiseptic solution and allowed to air dry. This helps reduce the number of bacteria on the skin and decreases the risk of infection from the procedure.

An ultrasound of the gallbladder is scheduled for the client with a suspected diagnosis of cholecystitis. Which should the nurse explain to the client about this test?

The test requires the client to lie still for short intervals. Rationale: Ultrasound of the gallbladder is a noninvasive procedure and is frequently used for emergency diagnosis of acute cholecystitis. The client may need to lie still during the procedure for short intervals of time while visualization of the gallbladder is done.

A client is scheduled for blood to be drawn from the radial artery for an arterial blood gas (ABG) determination. The nurse assists with performing Allen's test before drawing the blood to determine the adequacy of which?

Ulnar circulation Rationale: Before performing a radial puncture to obtain an arterial specimen for ABG values, Allen's test should be performed to determine adequate ulnar circulation. Failure to assess collateral circulation could result in severe ischemic injury to the hand if damage to the radial artery occurs with arterial puncture.

A client with ascites is scheduled for a paracentesis. The nurse is assisting the primary health care provider (PHCP) with performing the procedure. Which position should the nurse assist the client into for this procedure?

Upright Rationale: An upright position allows the intestine to float posteriorly and helps prevent intestinal laceration during catheter insertion.

A client with leukemia who had a bone marrow aspiration is thrombocytopenic. The nurse gives which instruction to the family as the client is discharged to home?

Watch the puncture site for bleeding for the next several days. Rationale: The client who is thrombocytopenic is at risk for bleeding. The family should observe the puncture site for bleeding for several days after the procedure. Acetaminophen may be given for discomfort, and acetylsalicylic acid (aspirin) should be avoided because it can aggravate bleeding.