TEST BANK for Mosby's Canadian Manual of Diagnostic and Laboratory Tests 2nd Edition by Pagana, Pike

Mosby’s Canadian Manual of Diagnostic and Laboratory Tests 2nd Edition Pagana Test Bank Pagana: Mosby’s Canadian Manual of Diagnostic and Laboratory Tests, 2nd Canadian Edition Practice Test

1. Which of these instructions should a nurse give an elderly, dehydrated patient after computed tomography (CT) of the kidney with intravenous iodine contrast material? a. Drink plenty of fluids for 24 hours b. Avoid heavy lifting for 2 days c. Use a laxative to clear the contrast from the bowel d. None of the above 2. For a patient with severe bone destruction from tumour or osteomalacia, what serum laboratory results would the nurse expect to assess? a. Decreased serum alkaline phosphatase (ALP) level b. Increased serum ALP level c. Decreased erythrocyte sedimentation rate d. Increased red blood cell count 3. A patient’s laboratory reports indicate the presence of Bence-Jones proteins. These levels are increased in the urine of patients who have: a. Multiple myeloma b. Carcinoid syndrome c. Breast cancer d. Colorectal cancer 4. A patient is admitted for evaluation of perforated diverticulitis. Which of the following is the most appropriate test? a. CT of the abdomen b. Barium enema c. Colonoscopy d. All the above 5. Blood urea nitrogen (BUN) levels may be abnormally low in which patients? a. Overly hydrated patients b. Patients with liver disease c. Malnourished patients in negative nitrogen balance d. All the above 6. The serum creatinine level is usually elevated in patients with which of the following? a. Renal disease b. Liver disease c. Lung disease d. Muscular disease 7. A patient presents with upper gastrointestinal bleeding from a suspected peptic ulcer.

Which of the following is the most appropriate test? a. Upper gastrointestinal radiography b. Gastric bleeding scan c. Esophagogastroduodenoscopy (EGD) d. None of the above 8. A patient is admitted with abdominal pain. Ultrasonography of the abdomen, CT of the abdomen, and a barium enema study have been ordered. In what order should these tests be performed? a. Ultrasonography, barium enema, CT b. Ultrasonography, CT, barium enema c. Barium enema, CT, ultrasonography d. CT, barium enema, ultrasonography 9. A patient is scheduled for a cardiac exercise stress test to evaluate chest pain. While obtaining the patient history, the clinician notes that the patient has intermittent claudication when walking two blocks. On the basis of this finding, which of the following is indicated? a. The test will be performed as scheduled b. The test is contraindicated because of the intermittent claudication c. The test will be rescheduled after resolution of the claudication d. The patient is a candidate for the dipyridamole-thallium (nonexercise) stress test 10. A patient is scheduled for a cardiac catheterization. Which of the following activities is a postprocedure nursing priority? a. Ambulating the patient b. Encouraging coughing and deep-breathing exercises c. Keeping the patient on NPO status (nothing by mouth) d. Keeping the involved extremity immobilized 11. One of the blood studies used to detect a myocardial infarction is creatine kinase (CK).

What value is most helpful for diagnosing a myocardial infarction? a. Total CK b. Isoenzyme CK-MM c. Isoenzyme CK-MB d. Isoenzyme CK-BB 12. During a patient’s exercise stress test, his blood pressure drops and he complains of feeling dizzy. What should the nurse do? a. Encourage the patient to take deep breaths b. Terminate the test immediately c. Take the vital signs d. Lay the patient flat 13. A patient had a lipid profile documented and asks about her results. Which of the following is considered the ideal high-density lipoprotein (HDL)/total cholesterol ratio? a. 1:2 b. 1:3

c. 1:4 d. 1:5 14. A patient underwent a tuberculin skin test 48 hours ago. He returns to the clinic for the nurse to read the test results. Which of the following is considered a positive result? a. A reddened area measuring 20 mm b. A flat, red area measuring 10 mm c. An indurated area measuring 8 mm d. An indurated area measuring 12 mm 15. A patient with diabetes was taken to the emergency department. His arterial blood gas results were as follows: pH: 7.25 Partial pressure of carbon dioxide (PCO2): 38 mm Hg HCO3- 19 mmol/L Partial pressure of oxygen (PO2): 95 mm Hg What do these results indicate? a. Respiratory acidosis b. Respiratory alkalosis c. Metabolic acidosis d. Metabolic alkalosis 16. A patient has just returned from the endoscopy suite, where he underwent bronchoscopy.

Which of the following is not a nursing priority after the procedure? a. Observing the sputum for N hemRorrI hagG e b. Monitoring the vital signs frequently c. Observing the patient closely for laryngospasm d. Encouraging cool fluids to comfort his throat 17. What is the best time of the day for obtaining a sputum specimen? a. Early morning b. After breakfast c. Evening d. The time does not matter 18. A patient is scheduled for magnetic resonance imaging (MRI). Which of the following factors is a contraindication to this procedure? a. Iodine allergy b. Severe visual impairment c. Cardiac pacemaker d. None of the above 19. Which of the following activities should be avoided before electroencephalography (EEG)? a. Washing the hair the night before the procedure b. Taking anticonvulsant medications c. Drinking caffeinated fluids such as regular coffee, tea, or cola

d. None of the above 20. After a lumbar puncture, a nursing priority is to prevent a spinal headache. Which of the following activities is to be avoided? a. Ambulating the patient in the room b. Drinking fluids through a straw c. Keeping the patient on bed rest d. Keeping the patient’s head flat 21. A patient is scheduled for lumbar puncture. Which of the following conditions is a contraindication to this procedure? a. Meningitis b. Neurosyphilis c. Multiple sclerosis d. Increased intracranial pressure (ICP) 22. Which of the following statements regarding a glycosylated hemoglobin test is false? a. The test provides an accurate long-term index of the patient’s average blood glucose level. b. The test aids in determining the duration of hyperglycemia in a patient with newly diagnosed diabetes. c. No fasting is required for this test. d. Short-term physiologic variations (e.g., those caused by food intake, exercise, and stress) affect the test result.

23. A patient has an elevated glucose level. Which of the following factors in his history may cause hyperglycemia? a. Insulinoma b. Corticosteroid therapy c. Hypothyroidism d. Addison’s disease 24. Cortisol levels normally rise and fall during the day. This fluctuation is referred to as the diurnal variation. At what time of the day are levels the highest? a. 8 AM b. Noon c. 4 PM d. Midnight 25. Symptoms that may indicate hypocalcaemia include which of the following? a. Nausea, vomiting, and anorexia b. Polyuria and dehydration c. Muscle weakness and coma d. Tetany and carpal pedal spasms 26. A patient has been diagnosed with primary hypothyroidism. Her triiodothyronine (T3) and thyroxine (T4) levels are decreased. What would a clinician expect the

thyroid-stimulating hormone (TSH) levels to be? a. Normal b. Increased c. Decreased d. Near zero 27. Often during a fetal nonstress test (fetal activity determination test), fetal activity must be stimulated. Which of the following stimuli is not part of this test? a. Rubbing the mother’s abdomen b. Administering intravenous oxytocin c. Ringing a bell near the abdomen d. Compressing the mother’s abdomen 28. Which of the following statements best describes the Sims-Huhner test? a. This test is an evaluation of the quality of cervical mucus. b. This test is an examination of cervical mucus for colour, viscosity, and tenacity. c. This test is an assessment of the number of motile sperm per high-power microscopic field. d. This test is an evaluation of the interaction between the sperm and cervical mucus.

29. Which of the following tests is used to screen blood for antibody compatibility before a blood transfusion? a. Direct Coombs test b. Indirect Coombs test c. Complete blood cell count d. Serum haptoglobin test 30. Which of the following statements is false with regard to the semen analysis test? a. A single sperm analysis can be conclusive evidence of male infertility. b. Men with little or no sperm should be evaluated for pituitary, thyroid, adrenal, or testicular aberrations. c. A 2- to 3-day period of sexual abstinence is necessary before collection of the semen specimen. d. For best results, a semen sample should be collected in the physician’s office or laboratory by means of masturbation.

31. Which of the following tests is used to monitor warfarin administration? a. Activated partial thromboplastin time b. Platelet count c. Bleeding time d. International normalized ratio (INR) 32. Which of the following factors may cause an increase in hematocrit concentration? a. Hemorrhage b. Bone marrow failure c. Pregnancy d. Dehydration

33. A “shift to the left” in white blood cell production indicates an acute bacterial infection.

Which of the following cells are increased in this situation? a. Mature neutrophils b. Monocytes c. Lymphocytes d. Band (or stab) cells 34. The physician orders a blood culture for a patient with suspected bacteremia. Which of the following statements is incorrect with regard to the collection of this specimen? a. Blood culture specimens should be drawn at the time the patient has a fever or chills. b. If the patient is receiving antibiotics already, the laboratory should be notified, and the blood culture specimen should be collected shortly before the next dose of antibiotic is administered. c. Two culture specimens should be obtained and from different sites. d. The culture specimen can be drawn at any time without regard to medications and vital signs.

35. Which of the following is a possible cause of hyperkalemia? a. Diarrhea and vomiting b. Diuretic drug therapy c. Cushing’s syndrome d. Acidosis 36. After returning from an esophN agU oR gaS stI roN dG uoT dB en. oC scopMy (EGD) and dilation of an esophageal stricture, a patient began to complain of fever and chest pain. What should the nurse suspect, and what is the most appropriate action? a. Myocardial infarction, and obtaining electrocardiography (ECG) immediately b. Gastroesophageal reflux, and administering an antacid c. Esophageal perforation, and notifying the physician immediately d. Dyspepsia from not eating before the procedure, and allowing the patient to eat bland food 37. After undergoing a barium enema study, what instruction should patients be given? a. Take an oral laxative to completely evacuate the barium. b. Try to retain the barium in case additional radiographic studies are needed the same day or the following day. c. Await normal bowel function. d. None of the above.

38. After returning from colonoscopy, a patient complains of increasing abdominal pain.

What is an appropriate nursing intervention? a. Limiting her diet to clear liquids b. Assisting her with a warm bath to soothe the anorectal area c. Administering a gentle enema to assist in evacuation of colon contents and air d. Administering a laxative to assist in evacuation of excess colon contents e. None of the above

39. A woman in her first trimester of pregnancy develops pain consistent with gallbladder disease. What is the most appropriate diagnostic test? a. Gallbladder ultrasonography b. Gallbladder radioscintigraphy scan c. Oral cholecystography d. Computed tomography 40. After a liver biopsy, the patient should: a. Ambulate to maintain mobility b. Lie on the left side c. Lie on the right side d. Lie prone 41. A nurse has been stuck by a needle from a patient being treated for hepatitis. What is the most appropriate action or actions? a. Immediate enteric and blood product precautions to isolate the involved nurse b. Immediately obtaining hepatitis viral studies on the affected nurse c. Hospitalizing the nurse for bed rest d. All the above e. None of the above 42. A patient’s leg has become swollen 1 week after arthroscopy. For what should he be evaluated? a. Hemarthrosis b. Joint stiffness after prolonged immobilization c. Postoperative thrombophlebitis d. Joint dislocation 43. A 5-year-old patient has fallen and injured her right arm during play therapy. Why does the physician order radiographs of both arms? a. The noninjured arm could have been injured in the fall. b. Fracture lines of long bones in children are difficult to distinguish from normal growth lines, which make comparison films necessary. c. The battered child syndrome can be diagnosed by documenting multiple fractures. d. All the above.

44. A patient has just undergone diagnostic arthroscopy and has mild discomfort. Which of the following interventions is most appropriate? a. Ambulating the patient b. Notifying the physician c. Applying ice to reduce swelling and pain d. Administering an intramuscular narcotic 45. What drug should be discontinued before the serum gastrin level is measured? a. Hydrochlorothiazide b. Propranolol (Inderal)

c. Cimetidine (Tagamet) d. All the above 46. Which of the following instructions should the nurse give a client after an upper gastrointestinal study? a. “Expect your stools to be chalky white for at least a day.” b. “Take a cathartic (such as milk of magnesia).” c. “Drink plenty of fluids when you get home.” d. All the above.

47. Which of the following test results would indicate a complication of endoscopic retrograde cholangiopancreatography (ERCP)? a. Red blood cells in the urine b. Elevated serum amylase level c. Elevated serum calcium level d. All the above 48. Carcinoembryonic antigen (CEA) is used to monitor patients with what condition? a. Colon cancer b. Breast cancer c. Gastric cancer d. All the above 49. Specific gravity in the urine is increased in patients with what condition? a. Dehydration b. Diabetes insipidus c. Chronic renal failure d. All the above 50. Intravenous pyelography (IVP) may be contraindicated in patients with what condition? a. Shellfish allergy b. Severe dehydration c. Renal insufficiency d. All the above 51. Immediately after undergoing kidney biopsy, a patient notices gross hematuria. What is the most appropriate nursing intervention? a. Collecting serial urine specimens b. Dehydrating the patient to diminish urine output and bleeding c. Notifying the physician immediately and obtaining a specimen for blood typing and crossmatching d. All the above 52. Which of the following foods may interfere with determining the results of urinary vanillylmandelic acid or catecholamines? a. Potatoes and red meat b. Coffee and licorice

c. Beer and salted pretzels d. All the above 53. A “no added salt” diet is necessary for patients before which of the following studies? a. Urine specific gravity b. IVP c. Plasma renin assay d. Renal scanning 54. What is the most specific test for identifying recurrent prostate cancer? a. Prostatic acid phosphatase measurement b. Prostate-specific antigen (PSA) measurement c. Digital rectal examination d. Transrectal ultrasonography 55. A nurse should ask the patient which of the following questions before scheduling an IVP? a. “Are you allergic to shellfish or iodine?” b. “Have you ever undergone IVP before?” c. “Are you able to drink a lot of fluids?” d. All the above 56. Before mammography, which of the following is or are appropriate information to give a patient? a. Mammography involves aNloUwRdSoI seNoG fT raB di. atC ion M and therefore can safely be performed annually. b. Mammography can reveal breast cancer before a tumour is clinically palpable. c. Although mammography is an accurate means of detecting breast cancer, it can result in false positives. d. All the above.

57. What is the most accurate method of screening for breast cancer? a. MRI of the breast b. Mammography c. Ultrasonography of the breast d. Physical examination 58. Which of the following tumour markers is associated with breast cancer? a. Alpha-fetoprotein b. Human chorionic gonadotropin c. CA–15-3 d. CA–125

Pagana: Mosby’s Canadian Manual of Diagnostic and Laboratory Tests, 2nd Canadian Edition Practice Test Answer Key

1. Which of these instructions should a nurse give an elderly, dehydrated patient after computed tomography (CT) of the kidney with intravenous iodine contrast material? a. Drink plenty of fluids for 24 hours b. Avoid heavy lifting for 2 days c. Use a laxative to clear the contrast from the bowel d. None of the above Answer: a Rationale: Elderly patients are often chronically dehydrated and therefore especially susceptible to renal impairment after receiving intravenous iodine contrast material. Not only is the use of laxatives unnecessary to eliminate the contrast material, but it will also further dehydrate the patient. No physical limitations are required.

Reference page: 1018 2. For a patient with severe bone destruction from tumour or osteomalacia, what serum laboratory results would the nurse expect to assess? a. Decreased serum alkaline phosphatase (ALP) level b. Increased serum ALP level NUentSatioNn raTte c. Decreased erythrocyte sedim d. Increased red blood cell count Answer: b Rationale: Patients with destructive bone diseases commonly have elevated ALP levels as a result of bone cell destruction and regeneration.

Reference page: 53 3. A patient’s laboratory reports indicate the presence of Bence-Jones proteins. These levels are increased in the urine of patients who have: a. Multiple myeloma b. Carcinoid syndrome c. Breast cancer d. Colorectal cancer Answer: a Rationale: Bence-Jones proteins are immunoglobulins that are commonly excreted in the urine of patients with multiple myeloma.

Reference page: 943 4. A patient is admitted for evaluation of perforated diverticulitis. Which of the following is the most appropriate test? a. CT of the abdomen

b. Barium enema c. Colonoscopy d. All the above Answer: a Rationale: CT is accurate for identifying an abdominal abscess. Colonoscopy and barium enema are contraindicated in patients with suspected perforated viscus.

Reference page: 1059 5. Blood urea nitrogen (BUN) levels may be abnormally low in which patients? a. Overly hydrated patients b. Patients with liver disease c. Malnourished patients in negative nitrogen balance d. All the above Answer: d Rationale: BUN levels can decrease normally in patients who are well hydrated.

Because liver function must be adequate to make urea, severe liver dysfunction is associated with decreased BUN levels. Because BUN also is a measure of protein nutrition, this level can be diminished in starving patients.

Reference page: 534 6. The serum creatinine level is usually elevated in patients with which of the following? a. Renal disease b. Liver disease c. Lung disease d. Muscular disease Answer: a Rationale: An elevated serum creatinine level indicates renal disease. No other diseased organ causes elevation of the serum creatinine level.

Reference page: 205 7. A patient presents with upper gastrointestinal bleeding from a suspected peptic ulcer.

Which of the following is the most appropriate test? a. Upper gastrointestinal radiography b. Gastric bleeding scan c. Esophagogastroduodenoscopy (EGD) d. None of the above Answer: c Rationale: EGD is the most accurate diagnostic test. Furthermore, transendoscopic coagulation of active bleeding can be performed with EGD. Reference page: 636 8. A patient is admitted with abdominal pain. Ultrasonography of the abdomen, CT of the abdomen, and a barium enema study have been ordered. In what order should these tests be

performed? a. Ultrasonography, barium enema, CT b. Ultrasonography, CT, barium enema c. Barium enema, CT, ultrasonography d. CT, barium enema, ultrasonography Answer: b Rationale: Ultrasonography should be performed first because intra-abdominal barium will distort the sound waves and thus decrease the accuracy. Also, if the ultrasonography of the abdomen includes water distension of the stomach, the patient will need to void before proceeding to CT to prevent discomfort. Likewise, barium within the bowel will distort the CT image. Therefore, ultrasonography should be done first, CT second, and barium enema last.

Reference page: 897 9. A patient is scheduled for a cardiac exercise stress test to evaluate chest pain. While obtaining the patient history, the clinician notes that the patient has intermittent claudication when walking two blocks. On the basis of this finding, which of the following is indicated? a. The test will be performed as scheduled b. The test is contraindicated because of the intermittent claudication c. The test will be rescheduled after resolution of the claudication d. The patient is a candidate for the dipyridamole-thallium (nonexercise) stress test Answer: d Rationale: The patient’s peripNhU erR alSvI asN cuGlaTrB d. iseCaseMwill cause calf pain during exercise.

This pain will probably precede exercise-induced chest pain and cause the test to be terminated prematurely.

Reference page: 565 10. A patient is scheduled for a cardiac catheterization. Which of the following activities is a postprocedure nursing priority? a. Ambulating the patient b. Encouraging coughing and deep-breathing exercises c. Keeping the patient on NPO status (nothing by mouth) d. Keeping the involved extremity immobilized Answer: d Rationale: The extremity in which the catheter was placed must be kept straight and immobilized for several hours after catheterization to prevent bleeding. Ice packs may minimize any swelling or hematoma at the catheter insertion site.

Reference page: 1052

11. One of the blood studies used to detect a myocardial infarction is creatine kinase (CK).

What value is most helpful for diagnosing a myocardial infarction? a. Total CK b. Isoenzyme CK-MM

c. Isoenzyme CK-MB d. Isoenzyme CK-BB Answer: c Rationale: The isoenzyme CK-MB provides a unique marker for damaged myocardial cells.

Reference page: 202 12. During a patient’s exercise stress test, his blood pressure drops and he complains of feeling dizzy. What should the nurse do? a. Encourage the patient to take deep breaths b. Terminate the test immediately c. Take the vital signs d. Lay the patient flat Answer: b Rationale: If the patient complains of chest pain, exhaustion, dyspnea, fatigue or dizziness, the test should be immediately terminated.

Reference page: 567 13. A patient had a lipid profile documented and asks about her results. Which of the following is considered the ideal high-density lipoprotein (HDL)/total cholesterol ratio? a. 1:2 b. 1:3 c. 1:4 d. 1:5 Answer: b Rationale: The ideal ratio of HDL/total cholesterol is 1:3. An acceptable ratio is at least 1:5.

Reference page: 356 14. A patient underwent a tuberculin skin test 48 hours ago. He returns to the clinic for the nurse to read the test results. Which of the following is considered a positive result? a. A reddened area measuring 20 mm b. A flat, red area measuring 10 mm c. An indurated area measuring 8 mm d. An indurated area measuring 12 mm Answer: d Rationale: An indurated (hardened) area measuring more than 10 mm is a positive result.

This means that the patient has been exposed to tuberculosis.

Reference page: 1172 15. A patient with diabetes was taken to the emergency department. His arterial blood gas results were as follows: pH: 7.25

Partial pressure of carbon dioxide (PCO2): 38 mm Hg HCO3- 19 mmol/L Partial pressure of oxygen (PO2): 95 mm Hg What do these results indicate? a. Respiratory acidosis b. Respiratory alkalosis c. Metabolic acidosis d. Metabolic alkalosis Answer: c Rationale: The pH indicates acidosis. The lower HCO3- value indicates a metabolic problem.

Reference page: 123 16. A patient has just returned from the endoscopy suite, where he underwent bronchoscopy.

Which of the following is not a nursing priority after the procedure? a. Observing the sputum for hemorrhage b. Monitoring the vital signs frequently c. Observing the patient closely for laryngospasm d. Encouraging cool fluids to comfort his throat Answer: d Rationale: The patient is kept on NPO status until the tracheobronchial anaesthesia has worn off and the gag reflex has returned. This usually occurs within 2 hours. A patient who drinks or eats before thisNtiU mR eS coI ulN dGasTpB ira.teCanM d develop pneumonia.

Reference page: 617 17. What is the best time of the day for obtaining a sputum specimen? a. Early morning b. After breakfast c. Evening d. The time does not matter Answer: a Rationale: Obtaining an early-morning specimen is best because secretions pool and collect in the lungs during sleep.

Reference page: 793 18. A patient is scheduled for magnetic resonance imaging (MRI). Which of the following factors is a contraindication to this procedure? a. Iodine allergy b. Severe visual impairment c. Cardiac pacemaker d. None of the above Answer: c Rationale: An implantable metal pacemaker is a contraindication for this procedure

because the magnet may move the object within the body and cause damage.

Reference page: 1148 19. Which of the following activities should be avoided before electroencephalography (EEG)? a. Washing the hair the night before the procedure b. Taking anticonvulsant medications c. Drinking caffeinated fluids such as regular coffee, tea, or cola d. None of the above Answer: c Rationale: Regular coffee, tea, and cola are not permitted on the morning of the study because of their stimulating effect.

Reference page: 575 20. After a lumbar puncture, a nursing priority is to prevent a spinal headache. Which of the following activities is to be avoided? a. Ambulating the patient in the room b. Drinking fluids through a straw c. Keeping the patient on bed rest d. Keeping the patient’s head flat Answer: a Rationale: Walking immediately after lumbar puncture may induce a headache. It is best for the patient to remain in beN d aUtRreS stIfoNrGabToBu. t 3C0 mMinutes.

Reference page: 683 21. A patient is scheduled for lumbar puncture. Which of the following conditions is a contraindication to this procedure? a. Meningitis b. Neurosyphilis c. Multiple sclerosis d. Increased intracranial pressure (ICP) Answer: d Rationale: Patients with increased ICP cannot undergo lumbar puncture because the lumbar puncture may induce cerebral or cerebellar herniation.

Reference page: 681 22. Which of the following statements regarding a glycosylated hemoglobin test is false? a. The test provides an accurate long-term index of the patient’s average blood glucose level. b. The test aids in determining the duration of hyperglycemia in a patient with newly diagnosed diabetes. c. No fasting is required for this test. d. Short-term physiologic variations (e.g., those caused by food intake, exercise, and stress) affect the test result.

Answer: d Rationale: An advantage of this test is that the blood sample can be drawn at any time because glycosylated hemoglobin is not affected by short-term physiologic variations.

Reference page: 281 23. A patient has an elevated glucose level. Which of the following factors in his history may cause hyperglycemia? a. Insulinoma b. Corticosteroid therapy c. Hypothyroidism d. Addison’s disease Answer: b Rationale: Corticosteroid therapy causes chemically induced diabetes.

Reference page: 271 24. Cortisol levels normally rise and fall during the day. This fluctuation is referred to as the diurnal variation. At what time of the day are levels the highest? a. 8 AM b. Noon c. 4 PM d. Midnight Answer: a Rationale: Cortisol levels are highest at approximately 6 AM to 8 AM and gradually fall during the day to the lowest point near midnight.

Reference page: 193 25. Symptoms that may indicate hypocalcaemia include which of the following? a. Nausea, vomiting, and anorexia b. Polyuria and dehydration c. Muscle weakness and coma d. Tetany and carpal pedal spasms Answer: d Rationale: Symptoms such as tetany and carpal pedal spasms indicate the need for a calcium level test to rule out hypocalcaemia. Nausea, vomiting, anorexia, and confusion are signs of hypercalcemia.

Reference page: 154 26. A patient has been diagnosed with primary hypothyroidism. Her triiodothyronine (T3) and thyroxine (T4) levels are decreased. What would a clinician expect the thyroid-stimulating hormone (TSH) levels to be? a. Normal b. Increased c. Decreased

d. Near zero Answer: b Rationale: Low levels of T3 and T4 are the underlying stimuli for TSH elevation.

Therefore, in primary hypothyroidism, a compensatory elevation of TSH level occurs.

Reference page: 500 27. Often during a fetal nonstress test (fetal activity determination test), fetal activity must be stimulated. Which of the following stimuli is not part of this test? a. Rubbing the mother’s abdomen b. Administering intravenous oxytocin c. Ringing a bell near the abdomen d. Compressing the mother’s abdomen Answer: b Rationale: Oxytocin administration is not used in the nonstress test. It is part of the contraction stress test (oxytocin challenge test).

Reference page: 597 28. Which of the following statements best describes the Sims-Huhner test? a. This test is an evaluation of the quality of cervical mucus. b. This test is an examination of cervical mucus for colour, viscosity, and tenacity. c. This test is an assessment of the number of motile sperm per high-power microscopic field. d. This test is an evaluation oNfU thR eS inI teN raG ctT ioB n. beCtw OeMen the sperm and cervical mucus.

Answer: d Rationale: Options a, b, and c are all performed as part of this test. However, this test is mainly used as a postcoital examination of the cervical mucus to determine the ability of the sperm to penetrate the mucus and maintain mobility.

Reference page: 701

29. Which of the following tests is used to screen blood for antibody compatibility before a blood transfusion? a. Direct Coombs test b. Indirect Coombs test c. Complete blood cell count d. Serum haptoglobin test Answer: b Rationale: The indirect Coombs test is used to determine whether the patient has antibodies to the red blood cell that he or she is about to receive by blood transfusion.

Reference page: 191 30. Which of the following statements is false with regard to the semen analysis test?

a. A single sperm analysis can be conclusive evidence of male infertility. b. Men with little or no sperm should be evaluated for pituitary, thyroid, adrenal, or testicular aberrations. c. A 2- to 3-day period of sexual abstinence is necessary before collection of the semen specimen. d. For best results, a semen sample should be collected in the physician’s office or laboratory by means of masturbation.

Answer: a Rationale: Because the sperm count varies from day to day, a single sperm analysis is inconclusive, especially if it indicates infertility.

Reference page: 607 31. Which of the following tests is used to monitor warfarin administration? a. Activated partial thromboplastin time b. Platelet count c. Bleeding time d. International normalized ratio (INR) Answer: d Rationale: To have uniform standards of prothrombin time results throughout the world, those results now include the INR value.

Reference page: 446 32. Which of the following factorN sm ayScI auNsG e aTnBin.cC reasM e in hematocrit concentration?

UR a. Hemorrhage b. Bone marrow failure c. Pregnancy d. Dehydration Answer: d Rationale: Dehydration causes the hematocrit value to be artificially high.

Reference page: 298 33. A “shift to the left” in white blood cell production indicates an acute bacterial infection.

Which of the following cells are increased in this situation? a. Mature neutrophils b. Monocytes c. Lymphocytes d. Band (or stab) cells Answer: d Rationale: Band, or stab, cells are immature forms of neutrophils that enter the circulation during an acute bacterial infection.

Reference page: 550

34. The physician orders a blood culture for a patient with suspected bacteremia. Which of the following statements is incorrect with regard to the collection of this specimen? a. Blood culture specimens should be drawn at the time the patient has a fever or chills. b. If the patient is receiving antibiotics already, the laboratory should be notified, and the blood culture specimen should be collected shortly before the next dose of antibiotic is administered. c. Two culture specimens should be obtained and from different sites. d. The culture specimen can be drawn at any time without regard to medications and vital signs.

Answer: d Rationale: Specimens should be collected as indicated in options a, b, and c.

Reference page: 737 35. Which of the following is a possible cause of hyperkalemia? a. Diarrhea and vomiting b. Diuretic drug therapy c. Cushing’s syndrome d. Acidosis Answer: d Rationale: Acidotic states tend to raise serum potassium levels by causing a shift of potassium out of the cell. All the other options (a, b, and c) are causes of hypokalemia.

Reference page: 423 36. After returning from an esophagogastroduodenoscopy (EGD) and dilation of an esophageal stricture, a patient began to complain of fever and chest pain. What should the nurse suspect, and what is the most appropriate action? a. Myocardial infarction, and obtaining electrocardiography (ECG) immediately b. Gastroesophageal reflux, and administering an antacid c. Esophageal perforation, and notifying the physician immediately d. Dyspepsia from not eating before the procedure, and allowing the patient to eat bland food Answer: c Rationale: Esophageal perforation is a complication associated with EGD, especially when the esophagus has been dilated. The nurse should notify the physician immediately, keep the patient on NPO status, maintain intravenous access, and record vital signs.

Reference page: 639 37. After undergoing a barium enema study, what instruction should patients be given? a. Take an oral laxative to completely evacuate the barium. b. Try to retain the barium in case additional radiographic studies are needed the same day or the following day. c. Await normal bowel function. d. None of the above.

Answer: a Rationale: A laxative should be provided to the patient to evacuate retained barium, which may cause an impaction. Stool will be light in colour until all barium has been expelled.

Reference page: 1037 38. After returning from colonoscopy, a patient complains of increasing abdominal pain.

What is an appropriate nursing intervention? a. Limiting her diet to clear liquids b. Assisting her with a warm bath to soothe the anorectal area c. Administering a gentle enema to assist in evacuation of colon contents and air d. Administering a laxative to assist in evacuation of excess colon contents e. None of the above Answer: e Rationale: Bowel perforation should be suspected. The patient should be kept on NPO status, and intravenous access should be maintained. The physician should be notified immediately and vital signs monitored.

Reference page: 622 39. A woman in her first trimester of pregnancy develops pain consistent with gallbladder disease. What is the most appropriate diagnostic test? a. Gallbladder ultrasonography b. Gallbladder radioscintigraphy scan c. Oral cholecystography d. Computed tomography Answer: a Rationale: This is the only test that does not expose the fetus to potentially harmful radiation.

Reference page: 897

40. After a liver biopsy, the patient should: a. Ambulate to maintain mobility b. Lie on the left side c. Lie on the right side d. Lie prone Answer: c Rationale: If the patient lies on the right side, the liver capsule is compressed against the chest wall, creating a tamponade for any hemorrhage or bile leak that may occur.

Reference page: 768

41. A nurse has been stuck by a needle from a patient being treated for hepatitis. What is the

most appropriate action or actions? a. Immediate enteric and blood product precautions to isolate the involved nurse b. Immediately obtaining hepatitis viral studies on the affected nurse c. Hospitalizing the nurse for bed rest d. All the above e. None of the above Answer: e Rationale: Enteric precautions isolating the nurse will not help because the hepatitis B and C viruses are bloodborne. Hepatitis viral tests do not yield positive results for 2 to 12 weeks after exposure. Hospitalization and bed rest are not required for cases of hepatitis exposure.

Reference page: 6 42. A patient’s leg has become swollen 1 week after arthroscopy. For what should he be evaluated? a. Hemarthrosis b. Joint stiffness after prolonged immobilization c. Postoperative thrombophlebitis d. Joint dislocation Answer: c Rationale: Thrombophlebitis is a complication associated with arthroscopy and usually occurs 5 to 10 days after surgery.

Reference page: 613 43. A 5-year-old patient has fallen and injured her right arm during play therapy. Why does the physician order radiographs of both arms? a. The noninjured arm could have been injured in the fall. b. Fracture lines of long bones in children are difficult to distinguish from normal growth lines, which make comparison films necessary. c. The battered child syndrome can be diagnosed by documenting multiple fractures. d. All the above.

Answer: b Rationale: Fracture lines of long bones in children often are difficult to distinguish on radiographic film from normal growth lines. Any line suspected of representing a fracture that is seen on both arms is not a fracture. It merely represents a normal growth pattern in the young child. However, such lines that are unilateral are considered fractures until proven otherwise.

Reference page: 1046 44. A patient has just undergone diagnostic arthroscopy and has mild swelling and discomfort. Which of the following interventions is most appropriate? a. Ambulating the patient b. Notifying the physician c. Applying ice to reduce swelling and pain

d. Administering an intramuscular narcotic Answer: c Rationale: For mild discomfort after diagnostic arthroscopy, applying ice usually controls the pain.

Reference page: 612 45. What drug should be discontinued before the serum gastrin level is measured? a. Hydrochlorothiazide b. Propranolol (Inderal) c. Cimetidine (Tagamet) d. All the above Answer: c Rationale: Cimetidine is a histamine antagonist, which diminishes gastric acid secretion.

The normal physiologic feedback mechanism factitiously elevates serum gastrin levels.

Reference page: 264 46. Which of the following instructions should the nurse give a client after an upper gastrointestinal study? a. “Expect your stools to be chalky white for at least a day.” b. “Take a cathartic (such as milk of magnesia).” c. “Drink plenty of fluids when you get home.” d. All the above.

Answer: d Rationale: After any barium contrast study, the nurse should recommend that the client use a laxative and drink plenty of fluids to help eliminate barium.

Reference page: 1037 47. Which of the following test results would indicate a complication of endoscopic retrograde cholangiopancreatography (ERCP)? a. Red blood cells in the urine b. Elevated serum amylase level c. Elevated serum calcium level d. All the above Answer: b Rationale: A known complication of ERCP is pancreatitis after injection of contrast material into the pancreatic duct. An elevated amylase level is diagnostic.

Reference page: 633 48. Carcinoembryonic antigen (CEA) is used to monitor patients with what condition? a. Colon cancer b. Breast cancer c. Gastric cancer d. All the above

Answer: d Rationale: Levels of CEA can be abnormal in patients with various carcinomas (e.g., gastrointestinal and breast carcinomas). Also, many benign diseases (e.g., diverticulitis, ulcerative colitis, and cirrhosis) may be associated with moderate elevations in CEA level.

Reference page: 159 49. Specific gravity in the urine is increased in patients with what condition? a. Dehydration b. Diabetes insipidus c. Chronic renal failure d. All the above Answer: a Rationale: Because the kidneys are reabsorbing all available free water, the excreted urine is concentrated. The urine is dilute in patients with diabetes insipidus and chronic renal failure.

Reference page: 1001 50. Intravenous pyelography (IVP) may be contraindicated in patients with what condition? a. Shellfish allergy b. Severe dehydration c. Renal insufficiency d. All the above Answer: d Rationale: Patients who are allergic to shellfish can also be allergic to iodine. Severely dehydrated patients can go into renal failure with iodine injection. Kidney function, when already diminished, can deteriorate with iodine injection.

Reference page: 1020 51. Immediately after undergoing kidney biopsy, a patient notices gross hematuria. What is the most appropriate nursing intervention? a. Collecting serial urine specimens b. Dehydrating the patient to diminish urine output and bleeding c. Notifying the physician immediately and obtaining a specimen for blood typing and crossmatching d. All the above Answer: a Rationale: After a kidney biopsy, it is not unusual for the patient to have hematuria for the first 24 hours. Urine samples may be collected in consecutive chronologic order to facilitate comparison for evaluation of hematuria. These are referred to as rack, or serial, urine samples.

Reference page: 785

52. Which of the following foods may interfere with determining the results of urinary vanillylmandelic acid or catecholamines? a. Potatoes and red meat b. Coffee and licorice c. Beer and salted pretzels d. All the above Answer: b Rationale: For patients in whom a 24-hour urine specimen is collected for assessment of vanillylmandelic acid or catecholamines, foods that generally should be restricted include coffee, tea, bananas, chocolate, licorice, citrus fruits, vanilla, and aspirin.

Reference page: 1011 53. A “no added salt” diet is necessary for patients before which of the following studies? a. Urine specific gravity b. IVP c. Plasma renin assay d. Renal scanning Answer: c Rationale: A high intake of sodium can cause a decrease in levels of plasma renin.

Reference page: 463 54. What is the most specific test N foU rR idS enItiN fyG inT gB re. cuCrreM nt prostate cancer? a. Prostatic acid phosphatase measurement b. Prostate-specific antigen (PSA) measurement c. Digital rectal examination d. Transrectal ultrasonography Answer: b Rationale: PSA measurement is more sensitive and more specific for recurrent prostate cancer than are other tumour markers. Because recurrence may develop outside the pelvis, digital rectal examination and transrectal ultrasonography would not identify recurrences in other locations.

Reference page: 434 55. A nurse should ask the patient which of the following questions before scheduling an IVP? a. “Are you allergic to shellfish or iodine?” b. “Have you ever undergone IVP before?” c. “Are you able to drink a lot of fluids?” d. All the above Answer: d Rationale: Patients who are allergic to shellfish or iodine will have an allergic reaction to the contrast material used during IVP. Having undergone IVP previously without a

reaction eliminates the possibility of serious anaphylactic reaction to the dye. Patients must be able to adequately hydrate themselves before and after administration of intravenous iodine to avoid subsequent renal impairment.

Reference page: 1082 56. Before mammography, which of the following is or are appropriate information to give a patient? a. Mammography involves a low dose of radiation and therefore can safely be performed annually. b. Mammography can reveal breast cancer before a tumour is clinically palpable. c. Although mammography is an accurate means of detecting breast cancer, it can result in false positives. d. All the above.

Answer: d Rationale: All the remarks concerning mammography are accurate.

Reference page: 1091 57. What is the most accurate method of screening for breast cancer? a. MRI of the breast b. Mammography c. Ultrasonography of the breast d. Physical examination Answer: b Rationale: Ultrasonography and physical examination have an accuracy level inferior to that of mammography. MRI is more sensitive than mammography, but its poor specificity (too many false-positive results) limits its use as a screening tool.

Reference page: 1086 58. Which of the following tumour markers is associated with breast cancer? a. Alpha-fetoprotein b. Human chorionic gonadotropin c. CA–15-3 d. CA–125 Answer: c Rationale: CA–15-3 is specific to breast cancer. CEA and CA–27-29 are other tumour markers that are helpful in the evaluation of a patient with breast cancer.

Reference page: 146

Pagana: Mosby's Canadian Manual of Diagnostic and Laboratory Tests, 1st Canadian Edition Practice Test

1. Which of these instructions should a nurse give an elderly, dehydrated patient after computed tomography (CT) of the kidney with intravenous iodine contrast material? a. Drink plenty of fluids for 24 hours. b. Avoid heavy lifting for 2 days. c. Use a laxative to clear the contrast from the bowel. d. None of the above.

2. For a patient with severe bone destruction from tumour or osteomalacia, what serum laboratory results would the nurse expect to assess? a. Decreased serum alkaline phosphatase (ALP) level b. Increased serum ALP level c. Decreased erythrocyte sedimentation rate d. Increased red blood cell count 3. A patient’s laboratory reports indicate the presence of Bence-Jones proteins. These levels are increased in the urine of patients who have: a. Multiple myeloma b. Carcinoid syndrome c. Breast cancer d. Colorectal cancer 4. A patient is admitted for evaluation of perforated diverticulitis. Which of the following is the most appropriate test? a. CT of the abdomen b. Barium enema c. Colonoscopy d. All the above 5. Blood urea nitrogen (BUN) levels may be abnormally low in which patients? a. Overly hydrated patients b. Patients with liver disease c. Malnourished patients in negative nitrogen balance d. All the above 6. The serum creatinine level is usually elevated in patients with which of the following? a. Renal disease b. Liver disease c. Lung disease d. Muscular disease

7. A patient presents with upper gastrointestinal bleeding from a suspected peptic ulcer.

Which of the following is the most appropriate test? a. Upper gastrointestinal radiography b. Gastric bleeding scan c. Esophagogastroduodenoscopy (EGD) d. None of the above 8. A patient is admitted with abdominal pain. Ultrasonography of the abdomen, CT of the abdomen, and a barium enema study have been ordered. In what order should these tests be performed? a. Ultrasonography, barium enema, CT b. Ultrasonography, CT, barium enema c. Barium enema, CT, ultrasonography d. CT, barium enema, ultrasonography 9. A patient is scheduled for a cardiac exercise stress test to evaluate chest pain. While obtaining the patient history, the clinician notes that the patient has intermittent claudication when walking two blocks. On the basis of this finding, which of the following is indicated? a. The test will be performed as scheduled. b. The test is contraindicated because of the intermittent claudication. c. The test will be rescheduled after resolution of the claudication. d. The patient is a candidate for the dipyridamole-thallium (nonexercise) stress test.

10. A patient is scheduled for a cardiac catheterization. Which of the following activities is a postprocedure nursing priority? a. Ambulating the patient b. Encouraging coughing and deep-breathing exercises c. Keeping the patient on NPO status (nothing by mouth) d. Keeping the involved extremity immobilized 11. One of the blood studies used to detect a myocardial infarction is creatine kinase (CK).

What value is most helpful for diagnosing a myocardial infarction? a. Total CK b. Isoenzyme CK-MM c. Isoenzyme CK-MB d. Isoenzyme CK-BB 12. During a patient’s exercise stress test, his blood pressure dropped. Which of the following activities should be avoided in the 2-hour period after the test? a. Walking b. Taking a hot shower c. Eating a light meal d. Resting in his bed

13. A patient had a lipid profile documented and asks about her results. Which of the following is considered the ideal high-density lipoprotein (HDL)/total cholesterol ratio? a. 1:2 b. 1:3 c. 1:4 d. 1:5 14. A patient underwent a tuberculin skin test 48 hours ago. He returns to the clinic for the nurse to read the test results. Which of the following is considered a positive result? a. A reddened area measuring 20 mm b. A flat, red area measuring 10 mm c. An indurated area measuring 8 mm d. An indurated area measuring 12 mm 15. A patient with diabetes was taken to the emergency department. His arterial blood gas results were as follows: pH: 7.25 Partial pressure of carbon dioxide (PCO2): 38 mm Hg HCO3-: 19 mmol/L Partial pressure of oxygen (PO2): 95 mm Hg What do these results indicate? a. Respiratory acidosis b. Respiratory alkalosis c. Metabolic acidosis d. Metabolic alkalosis 16. A patient has just returned from the endoscopy suite, where he underwent bronchoscopy.

Which of the following is not a nursing priority after the procedure? a. Observing the sputum for hemorrhage b. Monitoring the vital signs frequently c. Observing the patient closely for laryngospasm d. Encouraging cool fluids to comfort his throat 17. What is the best time of the day for obtaining a sputum specimen? a. Early morning b. After breakfast c. Evening d. The time does not matter 18. A patient is scheduled for magnetic resonance imaging (MRI). Which of the following factors is a contraindication to this procedure? a. Iodine allergy b. Severe visual impairment c. Cardiac pacemaker d. None of the above

19. Which of the following activities should be avoided before electroencephalography (EEG)? a. Washing the hair the night before the procedure b. Taking anticonvulsant medications c. Drinking caffeinated fluids such as regular coffee, tea, or cola d. None of the above 20. After a lumbar puncture, a nursing priority is to prevent a spinal headache. Which of the following activities is to be avoided? a. Ambulating the patient in the room b. Drinking fluids through a straw c. Keeping the patient on bed rest d. Keeping the patient’s head flat 21. A patient is scheduled for lumbar puncture. Which of the following conditions is a contraindication to this procedure? a. Meningitis b. Neurosyphilis c. Multiple sclerosis d. Increased intracranial pressure (ICP) 22. Which of the following statements regarding a glycosylated hemoglobin test is false? a. The test provides an accurate long-term index of the patient’s average blood glucose level. b. The test aids in determining the duration of hyperglycemia in a patient with newly diagnosed diabetes. c. No fasting is required for this test. d. Short-term physiologic variations (e.g., those caused by food intake, exercise, and stress) affect the test result.

23. A patient has an elevated glucose level. Which of the following factors in his history may cause hyperglycemia? a. Insulinoma b. Corticosteroid therapy c. Hypothyroidism d. Addison’s disease 24. Cortisol levels normally rise and fall during the day. This fluctuation is referred to as the diurnal variation. At what time of the day are levels the highest? a. 8 AM b. Noon c. 4 PM d. Midnight

25. Symptoms that may indicate hypocalcemia include which of the following? a. Nausea, vomiting, and anorexia b. Polyuria and dehydration c. Muscle weakness and coma d. Tetany and carpal pedal spasms 26. A patient has been diagnosed with primary hypothyroidism. Her triiodothyronine (T3) and thyroxine (T4) levels are decreased. What would a clinician expect the thyroidstimulating hormone (TSH) levels to be? a. Normal b. Increased c. Decreased d. Near zero 27. Often during a fetal nonstress test (fetal activity determination test), fetal activity must be stimulated. Which of the following stimuli is not part of this test? a. Rubbing the mother’s abdomen b. Administering intravenous oxytocin c. Ringing a bell near the abdomen d. Compressing the mother’s abdomen 28. Which of the following statements best describes the Sims-Huhner test? a. This test is an evaluation of the quality of cervical mucus. ceSrvIicNaG lm usCforMcolour, viscosity, and tenacity. b. This test is an examinationNoUfR TuBc. c. This test is an assessment of the number of motile sperm per high-power microscopic field. d. This test is an evaluation of the interaction between the sperm and cervical mucus.

29. Which of the following tests is used to screen blood for antibody compatibility before a blood transfusion? a. Direct Coombs test b. Indirect Coombs test c. Complete blood cell count d. Serum haptoglobin test 30. Which of the following statements is false with regard to the semen analysis test? a. A single sperm analysis can be conclusive evidence of male infertility. b. Men with little or no sperm should be evaluated for pituitary, thyroid, adrenal, or testicular aberrations. c. A 2- to 3-day period of sexual abstinence is necessary before collection of the semen specimen. d. For best results, a semen sample should be collected in the physician’s office or laboratory by means of masturbation.

31. Which of the following tests is used to monitor warfarin administration? a. Activated partial thromboplastin time b. Platelet count c. Bleeding time d. International normalized ratio (INR) 32. Which of the following factors may cause an increase in hematocrit concentration? a. Hemorrhage b. Bone marrow failure c. Pregnancy d. Dehydration 33. A “shift to the left” in white blood cell production indicates an acute bacterial infection.

Which of the following cells are increased in this situation? a. Mature neutrophils b. Monocytes c. Lymphocytes d. Band (or stab) cells 34. The physician orders a blood culture for a patient with suspected bacteremia. Which of the following statements is incorrect with regard to the collection of this specimen? a. Blood culture specimens should be drawn at the time the patient has a fever or chills. b. If the patient is receiving antibiotics already, the laboratory should be notified, and the blood culture specimeN n shR ouldIbeGcolB le. ctC ed sM hortly before the next dose of U S N T O antibiotic is administered. c. Two culture specimens should be obtained and from different sites. d. The culture specimen can be drawn at any time without regard to medications and vital signs.

35. Which of the following is a possible cause of hyperkalemia? a. Diarrhea and vomiting b. Diuretic drug therapy c. Cushing’s syndrome d. Acidosis 36. After returning from an esophagogastroduodenoscopy (EGD) and dilation of an esophageal stricture, a patient began to complain of fever and chest pain. What should the nurse suspect, and what is the most appropriate action? a. Myocardial infarction, and obtaining electrocardiography (ECG) immediately b. Gastroesophageal reflux, and administering an antacid c. Esophageal perforation, and notifying the physician immediately d. Dyspepsia from not eating before the procedure, and allowing the patient to eat bland food

37. After undergoing a barium enema study, what instruction should patients be given? a. Take an oral laxative to completely evacuate the barium. b. Try to retain the barium in case additional radiographic studies are needed the same day or the following day. c. Await normal bowel function. d. None of the above.

38. After returning from colonoscopy, a patient complains of increasing abdominal pain.

What is an appropriate nursing intervention? a. Limiting her diet to clear liquids b. Assisting her with a warm bath to soothe the anorectal area c. Administering a gentle enema to assist in evacuation of colon contents and air d. Administering a laxative to assist in evacuation of excess colon contents e. None of the above 39. A woman in her first trimester of pregnancy develops pain consistent with gallbladder disease. What is the most appropriate diagnostic test? a. Gallbladder ultrasonography b. Gallbladder radioscintigraphy scan c. Oral cholecystography d. Computed tomography 40. After a liver biopsy, the patient should: y a. Ambulate to maintain mobNilitR b. Lie on the left side c. Lie on the right side d. Lie prone 41. A nurse has been stuck by a needle from a patient being treated for hepatitis. What is the most appropriate action or actions? a. Immediate enteric and blood product precautions to isolate the involved nurse b. Immediately obtaining hepatitis viral studies on the affected nurse c. Hospitalizing the nurse for bed rest d. All the above e. None of the above 42. A patient’s leg has become swollen 1 week after arthroscopy. For what should he be evaluated? a. Hemarthrosis b. Joint stiffness after prolonged immobilization c. Postoperative thrombophlebitis d. Joint dislocation

43. A 5-year-old patient has fallen and injured her right arm during play therapy. Why does the physician order radiographs of both arms? a. The noninjured arm could have been injured in the fall. b. Fracture lines of long bones in children are difficult to distinguish from normal growth lines, which make comparison films necessary. c. The battered child syndrome can be diagnosed by documenting multiple fractures. d. All the above.

44. A patient has just undergone diagnostic arthroscopy and has mild discomfort. Which of the following interventions is most appropriate? a. Ambulating the patient b. Notifying the physician c. Administering a mild analgesic (e.g., acetaminophen) d. Administering an intramuscular narcotic 45. What drug should be discontinued before the serum gastrin level is measured? a. Hydrochlorothiazide b. Propranolol (Inderal) c. Cimetidine (Tagamet) d. All the above 46. Which of the following instructions should the nurse give a client after an upper gastrointestinal study? chU alR kySI whNitG eT foB r. atCleasMt a day.” a. “Expect your stools to be N b. “Take a cathartic (such as milk of magnesia).” c. “Drink plenty of fluids when you get home.” d. All the above.

47. Which of the following test results would indicate a complication of endoscopic retrograde cholangiopancreatography (ERCP)? a. Red blood cells in the urine b. Elevated serum amylase level c. Elevated serum calcium level d. All the above 48. Carcinoembryonic antigen (CEA) is used to monitor patients with what condition? a. Colon cancer b. Breast cancer c. Gastric cancer d. All the above 49. Specific gravity in the urine is increased in patients with what condition? a. Dehydration b. Diabetes insipidus c. Chronic renal failure d. All the above

50. Intravenous pyelography (IVP) may be contraindicated in patients with what condition? a. Shellfish allergy b. Severe dehydration c. Renal insufficiency d. All the above 51. Immediately after undergoing kidney biopsy, a patient notices gross hematuria. What is the most appropriate nursing intervention? a. Collecting serial urine specimens b. Dehydrating the patient to diminish urine output and bleeding c. Notifying the physician immediately and obtaining a specimen for blood typing and crossmatching d. All the above 52. Which of the following foods may interfere with determining the results of urinary vanillylmandelic acid or catecholamines? a. Potatoes and red meat b. Coffee and licorice c. Beer and salted pretzels d. All the above 53. A “no added salt” diet is necessary for patients before which of the following studies? a. Urine specific gravity b. IVP c. Plasma renin assay d. Renal scanning 54. What is the most specific test for identifying recurrent prostate cancer? a. Prostatic acid phosphatase measurement b. Prostate-specific antigen (PSA) measurement c. Digital rectal examination d. Transrectal ultrasonography 55. A nurse should ask the patient which of the following questions before scheduling IVP? a. “Are you allergic to shellfish or iodine?” b. “Have you ever undergone IVP before?” c. “Are you able to drink a lot of fluids?” d. All the above

Practice Test

10

56. Before mammography, which of the following is or are appropriate information to give a patient? a. Mammography involves a low dose of radiation and therefore can safely be performed annually. b. Mammography can reveal breast cancer 1 to 2 years before a tumour is clinically palpable. c. Although mammography is an accurate means of detecting breast cancer, it is only 85% accurate. d. All the above.

57. What is the most accurate method of screening for breast cancer? a. MRI of the breast b. Mammography c. Ultrasonography of the breast d. Physical examination 58. Which of the following tumour markers is associated with breast cancer? a. Alpha-fetoprotein b. Human chorionic gonadotropin c. CA–15-3 d. CA-125

Pagana: Mosby's Canadian Manual of Diagnostic and Laboratory Tests, 1st Canadian Edition Practice Test Answer Key

1. Which of these instructions should a nurse give an elderly, dehydrated patient after computed tomography (CT) of the kidney with intravenous iodine contrast material? a. Drink plenty of fluids for 24 hours. b. Avoid heavy lifting for 2 days. c. Use a laxative to clear the contrast from the bowel. d. None of the above.

Answer: a Rationale: Elderly patients often are chronically dehydrated and therefore especially susceptible to renal impairment after receiving intravenous iodine contrast material. Not only is the use of laxatives unnecessary to eliminate the contrast material, but it will also further dehydrate the patient. No physical limitations are required.

Reference page: 1073 2. For a patient with severe bone destruction from tumour or osteomalacia, what serum laboratory results would the nurse expect to assess? a. Decreased serum alkaline phosphatase (ALP) level b. Increased serum ALP level NUentSatioNn raTte c. Decreased erythrocyte sedim d. Increased red blood cell count Answer: b Rationale: Patients with destructive bone diseases commonly have elevated ALP levels as a result of bone cell destruction and regeneration.

Reference page: 58 3. A patient’s laboratory reports indicate the presence of Bence-Jones proteins. These levels are increased in the urine of patients who have: a. Multiple myeloma b. Carcinoid syndrome c. Breast cancer d. Colorectal cancer Answer: a Rationale: Bence-Jones proteins are immunoglobulins that are commonly excreted in the urine of patients with multiple myeloma.

Reference page: 1025

4. A patient is admitted for evaluation of perforated diverticulitis. Which of the following is the most appropriate test? a. CT of the abdomen b. Barium enema c. Colonoscopy d. All the above Answer: a Rationale: CT is accurate for identifying an abdominal abscess. Colonoscopy and barium enema are contraindicated in patients with suspected perforated viscus.

Reference page: 1073 5. Blood urea nitrogen (BUN) levels may be abnormally low in which patients? a. Overly hydrated patients b. Patients with liver disease c. Malnourished patients in negative nitrogen balance d. All the above Answer: d Rationale: BUN levels can decrease normally in patients who are well hydrated.

Because liver function must be adequate to make urea, severe liver dysfunction is associated with decreased BUN levels. Because BUN also is a measure of protein nutrition, this level can be diminished in starving patients.

Reference page: 578 6. The serum creatinine level is usually elevated in patients with which of the following? a. Renal disease b. Liver disease c. Lung disease d. Muscular disease Answer: a Rationale: An elevated serum creatinine level indicates renal disease. No other diseased organ causes elevation of the serum creatinine level.

Reference page: 218 7. A patient presents with upper gastrointestinal bleeding from a suspected peptic ulcer.

Which of the following is the most appropriate test? a. Upper gastrointestinal radiography b. Gastric bleeding scan c. Esophagogastroduodenoscopy (EGD) d. None of the above Answer: c Rationale: EGD is the most accurate diagnostic test. Furthermore, transendoscopic coagulation of active bleeding can be performed with EGD. Reference page: 689

8. A patient is admitted with abdominal pain. Ultrasonography of the abdomen, CT of the abdomen, and a barium enema study have been ordered. In what order should these tests be performed? a. Ultrasonography, barium enema, CT b. Ultrasonography, CT, barium enema c. Barium enema, CT, ultrasonography d. CT, barium enema, ultrasonography Answer: b Rationale: Ultrasonography should be performed first because intraabdominal barium will distort the sound waves and thus decrease the accuracy. Also, if the ultrasonography of the abdomen includes water distension of the stomach, the patient will need to void before proceeding to CT to prevent discomfort. Likewise, barium within the bowel will distort the CT image. Therefore ultrasonography should be done first, CT second, and barium enema last.

Reference page: 971 9. A patient is scheduled for a cardiac exercise stress test to evaluate chest pain. While obtaining the patient history, the clinician notes that the patient has intermittent claudication when walking two blocks. On the basis of this finding, which of the following is indicated? a. The test will be performed as scheduled. b. The test is contraindicated because of the intermittent claudication. c. The test will be rescheduleNdUaR fteSrI reN soGluTtiB on.oCf thMe claudication. d. The patient is a candidate for the dipyridamole-thallium (nonexercise) stress test.

Answer: d Rationale: The patient’s peripheral vascular disease will cause calf pain during exercise.

This pain probably will precede exercise-induced chest pain and cause the test to be terminated prematurely.

Reference page: 607 10. A patient is scheduled for a cardiac catheterization. Which of the following activities is a postprocedure nursing priority? a. Ambulating the patient b. Encouraging coughing and deep-breathing exercises c. Keeping the patient on NPO status (nothing by mouth) d. Keeping the involved extremity immobilized Answer: d Rationale: The extremity in which the catheter was placed must be kept straight and immobilized for several hours after catheterization to prevent bleeding. Ice packs may minimize any swelling or hematoma at the catheter insertion site.

Reference page: 1141

11. One of the blood studies used to detect a myocardial infarction is creatine kinase (CK).

What value is most helpful for diagnosing a myocardial infarction? a. Total CK b. Isoenzyme CK-MM c. Isoenzyme CK-MB d. Isoenzyme CK-BB Answer: c Rationale: The isoenzyme CK-MB provides a unique marker for damaged myocardial cells.

Reference page: 214 12. During a patient’s exercise stress test, his blood pressure dropped. Which of the following activities should be avoided in the 2-hour period after the test? a. Walking b. Taking a hot shower c. Eating a light meal d. Resting in his bed Answer: b Rationale: A hot shower may cause an increase in cutaneous vasodilation and lead to orthostatic hypotension.

Reference page: 607 13. A patient had a lipid profile dN ocU um ReSnIteN dG anTdBa. skC s abM out her results. Which of the following is considered the ideal high-density lipoprotein (HDL)/total cholesterol ratio? a. 1:2 b. 1:3 c. 1:4 d. 1:5 Answer: b Rationale: The ideal ratio of HDL/total cholesterol is 1:3. An acceptable ratio is at least 1:5.

Reference page: 383 14. A patient underwent a tuberculin skin test 48 hours ago. He returns to the clinic for the nurse to read the test results. Which of the following is considered a positive result? a. A reddened area measuring 20 mm b. A flat, red area measuring 10 mm c. An indurated area measuring 8 mm d. An indurated area measuring 12 mm Answer: d Rationale: An indurated (hardened) area measuring more than 10 mm is a positive result.

This means that the patient has been exposed to tuberculosis.

Reference page: 1279

15. A patient with diabetes was taken to the emergency department. His arterial blood gas results were as follows: pH: 7.25 Partial pressure of carbon dioxide (PCO2): 38 mm Hg HCO3- 19 mmol/L Partial pressure of oxygen (PO2): 95 mm Hg What do these results indicate? a. Respiratory acidosis b. Respiratory alkalosis c. Metabolic acidosis d. Metabolic alkalosis Answer: c Rationale: The pH indicates acidosis. The lower HCO3- value indicates a metabolic problem.

Reference page: 127 16. A patient has just returned from the endoscopy suite, where he underwent bronchoscopy.

Which of the following is not a nursing priority after the procedure? a. Observing the sputum for hemorrhage b. Monitoring the vital signs frequently c. Observing the patient closely for laryngospasm d. Encouraging cool fluids to comfort his throat Answer: d Rationale: The patient is kept on NPO status until the tracheobronchial anaesthesia has worn off and the gag reflex has returned. This usually occurs within 2 hours. A patient who drinks or eats before this time could aspirate and develop pneumonia.

Reference page: 664 17. What is the best time of the day for obtaining a sputum specimen? a. Early morning b. After breakfast c. Evening d. The time does not matter Answer: a Rationale: Obtaining an early-morning specimen is best because secretions pool and collect in the lungs during sleep.

Reference page: 864

18. A patient is scheduled for magnetic resonance imaging (MRI). Which of the following factors is a contraindication to this procedure? a. Iodine allergy b. Severe visual impairment c. Cardiac pacemaker d. None of the above Answer: c Rationale: An implantable metal pacemaker is a contraindication for this procedure because the magnet may move the object within the body and cause damage.

Reference page: 1256 19. Which of the following activities should be avoided before electroencephalography (EEG)? a. Washing the hair the night before the procedure b. Taking anticonvulsant medications c. Drinking caffeinated fluids such as regular coffee, tea, or cola d. None of the above Answer: c Rationale: Regular coffee, tea, and cola are not permitted on the morning of the study because of their stimulating effect.

Reference page: 619 20. After a lumbar puncture, a nuN rsiU nR g pSrI iorN itG yT isBto.pCrevM ent a spinal headache. Which of the following activities is to be avoided? a. Ambulating the patient in the room b. Drinking fluids through a straw c. Keeping the patient on bed rest d. Keeping the patient’s head flat Answer: a Rationale: Walking immediately after lumbar puncture may induce a headache. It is best for the patient to remain in bed at rest for about 30 minutes.

Reference page: 735 21. A patient is scheduled for lumbar puncture. Which of the following conditions is a contraindication to this procedure? a. Meningitis b. Neurosyphilis c. Multiple sclerosis d. Increased intracranial pressure (ICP) Answer: d Rationale: Patients with increased ICP cannot undergo lumbar puncture because the lumbar puncture may induce cerebral or cerebellar herniation.

Reference page: 735

22. Which of the following statements regarding a glycosylated hemoglobin test is false? a. The test provides an accurate long-term index of the patient’s average blood glucose level. b. The test aids in determining the duration of hyperglycemia in a patient with newly diagnosed diabetes. c. No fasting is required for this test. d. Short-term physiologic variations (e.g., those caused by food intake, exercise, and stress) affect the test result.

Answer: d Rationale: An advantage of this test is that the blood sample can be drawn at any time because glycosylated hemoglobin is not affected by short-term physiologic variations.

Reference page: 301 23. A patient has an elevated glucose level. Which of the following factors in his history may cause hyperglycemia? a. Insulinoma b. Corticosteroid therapy c. Hypothyroidism d. Addison’s disease Answer: b Rationale: Corticosteroid therapy causes chemically induced diabetes.

Reference page: 286 24. Cortisol levels normally rise and fall during the day. This fluctuation is referred to as the diurnal variation. At what time of the day are levels the highest? a. 8 am b. Noon c. 4 pm d. Midnight Answer: a Rationale: Cortisol levels are highest at approximately 6 AM to 8 AM and gradually fall during the day to the lowest point near midnight.

Reference page: 204 25. Symptoms that may indicate hypocalcemia include which of the following? a. Nausea, vomiting, and anorexia b. Polyuria and dehydration c. Muscle weakness and coma d. Tetany and carpal pedal spasms

Answer: d Rationale: Symptoms such as tetany and carpal pedal spasms indicate the need for a calcium level test to rule out hypocalcemia. Nausea, vomiting, anorexia, and confusion are signs of hypercalcemia.

Reference page: 159 26. A patient has been diagnosed with primary hypothyroidism. Her triiodothyronine (T3) and thyroxine (T4) levels are decreased. What would a clinician expect the thyroidstimulating hormone (TSH) levels to be? a. Normal b. Increased c. Decreased d. Near zero Answer: b Rationale: Low levels of T3 and T4 are the underlying stimuli for TSH elevation.

Therefore, in primary hypothyroidism, a compensatory elevation of TSH level occurs.

Reference page: 535 27. Often during a fetal nonstress test (fetal activity determination test), fetal activity must be stimulated. Which of the following stimuli is not part of this test? a. Rubbing the mother’s abdomen b. Administering intravenous oxytocin c. Ringing a bell near the abdomen d. Compressing the mother’sNaU bdRoS mI enN Answer: b Rationale: Oxytocin administration is not used in the nonstress test. It is part of the contraction stress test (oxytocin challenge test).

Reference page: 642 28. Which of the following statements best describes the Sims-Huhner test? a. This test is an evaluation of the quality of cervical mucus. b. This test is an examination of cervical mucus for colour, viscosity, and tenacity. c. This test is an assessment of the number of motile sperm per high-power microscopic field. d. This test is an evaluation of the interaction between the sperm and cervical mucus.

Answer: d Rationale: Options a, b, and c are all performed as part of this test. However, this test is mainly used as a postcoital examination of the cervical mucus to determine the ability of the sperm to penetrate the mucus and maintain mobility.

Reference page: 763

29. Which of the following tests is used to screen blood for antibody compatibility before a blood transfusion? a. Direct Coombs test b. Indirect Coombs test c. Complete blood cell count d. Serum haptoglobin test Answer: b Rationale: The indirect Coombs test is used to determine whether the patient has antibodies to the red blood cell that he or she is about to receive by blood transfusion.

Reference page: 202 30. Which of the following statements is false with regard to the semen analysis test? a. A single sperm analysis can be conclusive evidence of male infertility. b. Men with little or no sperm should be evaluated for pituitary, thyroid, adrenal, or testicular aberrations. c. A 2- to 3-day period of sexual abstinence is necessary before collection of the semen specimen. d. For best results, a semen sample should be collected in the physician’s office or laboratory by means of masturbation.

Answer: a Rationale: Because the sperm count varies from day to day, a single sperm analysis is inconclusive, especially if it indicates infertility.

Reference page: 757 31. Which of the following tests is used to monitor warfarin administration? a. Activated partial thromboplastin time b. Platelet count c. Bleeding time d. International normalized ratio (INR) Answer: d Rationale: To have uniform standards of prothrombin time results throughout the world, those results now include the INR value.

Reference page: 482 32. Which of the following factors may cause an increase in hematocrit concentration? a. Hemorrhage b. Bone marrow failure c. Pregnancy d. Dehydration Answer: d Rationale: Dehydration causes the hematocrit value to be artificially high.

Reference page: 317

33. A “shift to the left” in white blood cell production indicates an acute bacterial infection.

Which of the following cells are increased in this situation? a. Mature neutrophils b. Monocytes c. Lymphocytes d. Band (or stab) cells Answer: d Rationale: Band, or stab, cells are immature forms of neutrophils that enter the circulation during an acute bacterial infection.

Reference page: 591 34. The physician orders a blood culture for a patient with suspected bacteremia. Which of the following statements is incorrect with regard to the collection of this specimen? a. Blood culture specimens should be drawn at the time the patient has a fever or chills. b. If the patient is receiving antibiotics already, the laboratory should be notified, and the blood culture specimen should be collected shortly before the next dose of antibiotic is administered. c. Two culture specimens should be obtained and from different sites. d. The culture specimen can be drawn at any time without regard to medications and vital signs.

Answer: d Rationale: Specimens shouldNbU eR coS llI ecN teG dT asBi. ndCicatM ed in options a, b, and c.

Reference page: 804 35. Which of the following is a possible cause of hyperkalemia? a. Diarrhea and vomiting b. Diuretic drug therapy c. Cushing’s syndrome d. Acidosis Answer: d Rationale: Acidotic states tend to raise serum potassium levels by causing a shift of potassium out of the cell. All the other options (a, b, and c) are causes of hypokalemia.

Reference page: 453 36. After returning from an esophagogastroduodenoscopy (EGD) and dilation of an esophageal stricture, a patient began to complain of fever and chest pain. What should the nurse suspect, and what is the most appropriate action? a. Myocardial infarction, and obtaining electrocardiography (ECG) immediately b. Gastroesophageal reflux, and administering an antacid c. Esophageal perforation, and notifying the physician immediately d. Dyspepsia from not eating before the procedure, and allowing the patient to eat bland food

Answer: c Rationale: Esophageal perforation is a complication associated with EGD, especially when the esophagus has been dilated. The nurse should notify the physician immediately, keep the patient on NPO status, maintain intravenous access, and record vital signs.

Reference page: 689 37. After undergoing a barium enema study, what instruction should patients be given? a. Take an oral laxative to completely evacuate the barium. b. Try to retain the barium in case additional radiographic studies are needed the same day or the following day. c. Await normal bowel function. d. None of the above.

Answer: a Rationale: A laxative should be provided to the patient to evacuate retained barium, which may cause an impaction. Stool will be light in colour until all barium has been expelled.

Reference page: 1124 38. After returning from colonoscopy, a patient complains of increasing abdominal pain.

What is an appropriate nursing intervention? a. Limiting her diet to clear liquids b. Assisting her with a warm bath to soothe the anorectal area c. Administering a gentle enema to assist in evacuation of colon contents and air d. Administering a laxative tN oU asR siS stI inNeG vaTcB ua.tiC onOoMf excess colon contents e. None of the above Answer: e Rationale: Bowel perforation should be suspected. The patient should be kept on NPO status, and intravenous access should be maintained. The physician should be notified immediately and vital signs monitored.

Reference page: 670 39. A woman in her first trimester of pregnancy develops pain consistent with gallbladder disease. What is the most appropriate diagnostic test? a. Gallbladder ultrasonography b. Gallbladder radioscintigraphy scan c. Oral cholecystography d. Computed tomography Answer: a Rationale: This is the only test that does not expose the fetus to potentially harmful radiation.

Reference page: 971

40. After a liver biopsy, the patient should: a. Ambulate to maintain mobility b. Lie on the left side c. Lie on the right side d. Lie prone Answer: c Rationale: If the patient lies on the right side, the liver capsule is compressed against the chest wall, creating a tamponade for any hemorrhage or bile leak that may occur.

Reference page: 834

41. A nurse has been stuck by a needle from a patient being treated for hepatitis. What is the most appropriate action or actions? a. Immediate enteric and blood product precautions to isolate the involved nurse b. Immediately obtaining hepatitis viral studies on the affected nurse c. Hospitalizing the nurse for bed rest d. All the above e. None of the above Answer: e Rationale: Enteric precautions isolating the nurse will not help because the hepatitis B and C viruses are bloodborne. Hepatitis viral tests do not yield positive results for 2 to 12 weeks after exposure. Hospitalization and bed rest are not required for cases of hepatitis exposure.

Reference page: 328 42. A patient’s leg has become swollen 1 week after arthroscopy. For what should he be evaluated? a. Hemarthrosis b. Joint stiffness after prolonged immobilization c. Postoperative thrombophlebitis d. Joint dislocation Answer: c Rationale: Thrombophlebitis is a complication associated with arthroscopy and usually occurs 5 to 10 days after surgery.

Reference page: 661 43. A 5-year-old patient has fallen and injured her right arm during play therapy. Why does the physician order radiographs of both arms? a. The noninjured arm could have been injured in the fall. b. Fracture lines of long bones in children are difficult to distinguish from normal growth lines, which make comparison films necessary. c. The battered child syndrome can be diagnosed by documenting multiple fractures. d. All the above.

Answer: b Rationale: Fracture lines of long bones in children often are difficult to distinguish on radiographic film from normal growth lines. Any line suspected of representing a fracture that is seen on both arms is not a fracture. It merely represents a normal growth pattern in the young child. However, such lines that are unilateral are considered fractures until proven otherwise.

Reference page: 1139 44. A patient has just undergone diagnostic arthroscopy and has mild discomfort. Which of the following interventions is most appropriate? a. Ambulating the patient b. Notifying the physician c. Administering a mild analgesic (e.g., acetaminophen) d. Administering an intramuscular narcotic Answer: c Rationale: For mild discomfort after diagnostic arthroscopy, a mild analgesic usually controls the pain.

Reference page: 661 45. What drug should be discontinued before the serum gastrin level is measured? a. Hydrochlorothiazide b. Propranolol (Inderal) c. Cimetidine (Tagamet) d. All the above Answer: c Rationale: Cimetidine is a histamine antagonist, which diminishes gastric acid secretion.

The normal physiologic feedback mechanism factitiously elevates serum gastrin levels.

Reference page: 280 46. Which of the following instructions should the nurse give a client after an upper gastrointestinal study? a. “Expect your stools to be chalky white for at least a day.” b. “Take a cathartic (such as milk of magnesia).” c. “Drink plenty of fluids when you get home.” d. All the above.

Answer: d Rationale: After any barium contrast study, the nurse should recommend that the client use a laxative and drink plenty of fluids to help eliminate barium.

Reference page: 1222

47. Which of the following test results would indicate a complication of endoscopic retrograde cholangiopancreatography (ERCP)? a. Red blood cells in the urine b. Elevated serum amylase level c. Elevated serum calcium level d. All the above Answer: b Rationale: A known complication of ERCP is pancreatitis after injection of contrast material into the pancreatic duct. An elevated amylase level is diagnostic.

Reference page: 685 48. Carcinoembryonic antigen (CEA) is used to monitor patients with what condition? a. Colon cancer b. Breast cancer c. Gastric cancer d. All the above Answer: d Rationale: Levels of CEA can be abnormal in patients with various carcinomas (e.g., gastrointestinal and breast carcinomas). Also, many benign diseases (e.g., diverticulitis, ulcerative colitis, and cirrhosis) may be associated with moderate elevations in CEA level.

Reference page: 167 49. Specific gravity in the urine is increased in patients with what condition? a. Dehydration b. Diabetes insipidus c. Chronic renal failure d. All the above Answer: a Rationale: Because the kidneys are reabsorbing all available free water, the excreted urine is concentrated. The urine is dilute in patients with diabetes insipidus and chronic renal failure.

Reference page: 1073 50. Intravenous pyelography (IVP) may be contraindicated in patients with what condition? a. Shellfish allergy b. Severe dehydration c. Renal insufficiency d. All the above

Answer: d Rationale: Patients who are allergic to shellfish also can be allergic to iodine. Severely dehydrated patients can go into renal failure with iodine injection. Kidney function, when already diminished, can deteriorate with iodine injection.

Reference page: 1178 51. Immediately after undergoing kidney biopsy, a patient notices gross hematuria. What is the most appropriate nursing intervention? a. Collecting serial urine specimens b. Dehydrating the patient to diminish urine output and bleeding c. Notifying the physician immediately and obtaining a specimen for blood typing and crossmatching d. All the above Answer: a Rationale: After a kidney biopsy, it is not unusual for the patient to have hematuria for the first 24 hours. Urine samples may be collected in consecutive chronologic order to facilitate comparison for evaluation of hematuria. These are referred to as rack, or serial, urine samples.

Reference page: 852 52. Which of the following foods may interfere with determining the results of urinary vanillylmandelic acid or catecholamines? a. Potatoes and red meat b. Coffee and licorice c. Beer and salted pretzels d. All the above Answer: b Rationale: For patients in whom a 24-hour urine specimen is collected for assessment of vanillylmandelic acid or catecholamines, foods that generally should be restricted include coffee, tea, bananas, chocolate, licorice, citrus fruits, vanilla, and aspirin.

Reference page: 1095 53. A “no added salt” diet is necessary for patients before which of the following studies? a. Urine specific gravity b. IVP c. Plasma renin assay d. Renal scanning Answer: c Rationale: A high intake of sodium can cause a decrease in levels of plasma renin.

Reference page: 498

54. What is the most specific test for identifying recurrent prostate cancer? a. Prostatic acid phosphatase measurement b. Prostate-specific antigen (PSA) measurement c. Digital rectal examination d. Transrectal ultrasonography Answer: b Rationale: PSA measurement is more sensitive and more specific for recurrent prostate cancer than are other tumour markers. Because recurrence may develop outside the pelvis, digital rectal examination and transrectal ultrasonography would not identify recurrences in other locations.

Reference page: 468 55. A nurse should ask the patient which of the following questions before scheduling IVP? a. “Are you allergic to shellfish or iodine?” b. “Have you ever undergone IVP before?” c. “Are you able to drink a lot of fluids?” d. All the above Answer: d Rationale: Patients who are allergic to shellfish or iodine will have an allergic reaction to the contrast material used during IVP. Having undergone IVP previously without a reaction eliminates the possibility of serious anaphylactic reaction to the dye. Patients must be able to adequately hydrate themselves before and after administration of intravenous iodine to avoid suN bsU eR quS eI nt N reGnaTlB im .pCairm Ment.

Reference page: 1178 56. Before mammography, which of the following is or are appropriate information to give a patient? a. Mammography involves a low dose of radiation and therefore can safely be performed annually. b. Mammography can reveal breast cancer 1 to 2 years before a tumour is clinically palpable. c. Although mammography is an accurate means of detecting breast cancer, it is only 85% accurate. d. All the above.

Answer: d Rationale: All the remarks concerning mammography are accurate.

Reference page: 1187 57. What is the most accurate method of screening for breast cancer? a. MRI of the breast b. Mammography c. Ultrasonography of the breast d. Physical examination

Practice Test Answer Key

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Answer: b Rationale: Ultrasonography and physical examination have an accuracy level inferior to that of mammography. MRI is more sensitive than mammography, but its poor specificity (too many false-positive results) limits its use as a screening tool.

Reference page: 1209 58. Which of the following tumour markers is associated with breast cancer? a. Alpha-fetoprotein b. Human chorionic gonadotropin c. CA–15-3 d. CA-125 Answer: c Rationale: CA–15-3 is specific to breast cancer. CEA and CA–27-29 are other tumour markers that are helpful in the evaluation of a patient with breast cancer.

Reference page: 152

Pagana: Mosby's Canadian Manual of Diagnostic and Laboratory Tests, 1st Canadian Edition Practice Test

1. Which of these instructions should a nurse give an elderly, dehydrated patient after computed tomography (CT) of the kidney with intravenous iodine contrast material? a. Drink plenty of fluids for 24 hours. b. Avoid heavy lifting for 2 days. c. Use a laxative to clear the contrast from the bowel. d. None of the above.

2. For a patient with severe bone destruction from tumour or osteomalacia, what serum laboratory results would the nurse expect to assess? a. Decreased serum alkaline phosphatase (ALP) level b. Increased serum ALP level c. Decreased erythrocyte sedimentation rate d. Increased red blood cell count 3. A patient’s laboratory reports indicate the presence of Bence-Jones proteins. These levels are increased in the urine of patients who have: a. Multiple myeloma b. Carcinoid syndrome c. Breast cancer d. Colorectal cancer 4. A patient is admitted for evaluation of perforated diverticulitis. Which of the following is the most appropriate test? a. CT of the abdomen b. Barium enema c. Colonoscopy d. All the above 5. Blood urea nitrogen (BUN) levels may be abnormally low in which patients? a. Overly hydrated patients b. Patients with liver disease c. Malnourished patients in negative nitrogen balance d. All the above 6. The serum creatinine level is usually elevated in patients with which of the following? a. Renal disease b. Liver disease c. Lung disease d. Muscular disease

7. A patient presents with upper gastrointestinal bleeding from a suspected peptic ulcer.

Which of the following is the most appropriate test? a. Upper gastrointestinal radiography b. Gastric bleeding scan c. Esophagogastroduodenoscopy (EGD) d. None of the above 8. A patient is admitted with abdominal pain. Ultrasonography of the abdomen, CT of the abdomen, and a barium enema study have been ordered. In what order should these tests be performed? a. Ultrasonography, barium enema, CT b. Ultrasonography, CT, barium enema c. Barium enema, CT, ultrasonography d. CT, barium enema, ultrasonography 9. A patient is scheduled for a cardiac exercise stress test to evaluate chest pain. While obtaining the patient history, the clinician notes that the patient has intermittent claudication when walking two blocks. On the basis of this finding, which of the following is indicated? a. The test will be performed as scheduled. b. The test is contraindicated because of the intermittent claudication. c. The test will be rescheduled after resolution of the claudication. d. The patient is a candidate for the dipyridamole-thallium (nonexercise) stress test.

10. A patient is scheduled for a cardiac catheterization. Which of the following activities is a postprocedure nursing priority? a. Ambulating the patient b. Encouraging coughing and deep-breathing exercises c. Keeping the patient on NPO status (nothing by mouth) d. Keeping the involved extremity immobilized 11. One of the blood studies used to detect a myocardial infarction is creatine kinase (CK).

What value is most helpful for diagnosing a myocardial infarction? a. Total CK b. Isoenzyme CK-MM c. Isoenzyme CK-MB d. Isoenzyme CK-BB 12. During a patient’s exercise stress test, his blood pressure dropped. Which of the following activities should be avoided in the 2-hour period after the test? a. Walking b. Taking a hot shower c. Eating a light meal d. Resting in his bed

13. A patient had a lipid profile documented and asks about her results. Which of the following is considered the ideal high-density lipoprotein (HDL)/total cholesterol ratio? a. 1:2 b. 1:3 c. 1:4 d. 1:5 14. A patient underwent a tuberculin skin test 48 hours ago. He returns to the clinic for the nurse to read the test results. Which of the following is considered a positive result? a. A reddened area measuring 20 mm b. A flat, red area measuring 10 mm c. An indurated area measuring 8 mm d. An indurated area measuring 12 mm 15. A patient with diabetes was taken to the emergency department. His arterial blood gas results were as follows: pH: 7.25 Partial pressure of carbon dioxide (PCO2): 38 mm Hg HCO3-: 19 mmol/L Partial pressure of oxygen (PO2): 95 mm Hg What do these results indicate? a. Respiratory acidosis b. Respiratory alkalosis c. Metabolic acidosis d. Metabolic alkalosis 16. A patient has just returned from the endoscopy suite, where he underwent bronchoscopy.

Which of the following is not a nursing priority after the procedure? a. Observing the sputum for hemorrhage b. Monitoring the vital signs frequently c. Observing the patient closely for laryngospasm d. Encouraging cool fluids to comfort his throat 17. What is the best time of the day for obtaining a sputum specimen? a. Early morning b. After breakfast c. Evening d. The time does not matter 18. A patient is scheduled for magnetic resonance imaging (MRI). Which of the following factors is a contraindication to this procedure? a. Iodine allergy b. Severe visual impairment c. Cardiac pacemaker d. None of the above

19. Which of the following activities should be avoided before electroencephalography (EEG)? a. Washing the hair the night before the procedure b. Taking anticonvulsant medications c. Drinking caffeinated fluids such as regular coffee, tea, or cola d. None of the above 20. After a lumbar puncture, a nursing priority is to prevent a spinal headache. Which of the following activities is to be avoided? a. Ambulating the patient in the room b. Drinking fluids through a straw c. Keeping the patient on bed rest d. Keeping the patient’s head flat 21. A patient is scheduled for lumbar puncture. Which of the following conditions is a contraindication to this procedure? a. Meningitis b. Neurosyphilis c. Multiple sclerosis d. Increased intracranial pressure (ICP) 22. Which of the following statements regarding a glycosylated hemoglobin test is false? a. The test provides an accurate long-term index of the patient’s average blood glucose level. b. The test aids in determining the duration of hyperglycemia in a patient with newly diagnosed diabetes. c. No fasting is required for this test. d. Short-term physiologic variations (e.g., those caused by food intake, exercise, and stress) affect the test result.

23. A patient has an elevated glucose level. Which of the following factors in his history may cause hyperglycemia? a. Insulinoma b. Corticosteroid therapy c. Hypothyroidism d. Addison’s disease 24. Cortisol levels normally rise and fall during the day. This fluctuation is referred to as the diurnal variation. At what time of the day are levels the highest? a. 8 AM b. Noon c. 4 PM d. Midnight

25. Symptoms that may indicate hypocalcemia include which of the following? a. Nausea, vomiting, and anorexia b. Polyuria and dehydration c. Muscle weakness and coma d. Tetany and carpal pedal spasms 26. A patient has been diagnosed with primary hypothyroidism. Her triiodothyronine (T3) and thyroxine (T4) levels are decreased. What would a clinician expect the thyroidstimulating hormone (TSH) levels to be? a. Normal b. Increased c. Decreased d. Near zero 27. Often during a fetal nonstress test (fetal activity determination test), fetal activity must be stimulated. Which of the following stimuli is not part of this test? a. Rubbing the mother’s abdomen b. Administering intravenous oxytocin c. Ringing a bell near the abdomen d. Compressing the mother’s abdomen 28. Which of the following statements best describes the Sims-Huhner test? a. This test is an evaluation of the quality of cervical mucus. ceSrvIicNaG lm usCforMcolour, viscosity, and tenacity. b. This test is an examinationNoUfR TuBc. c. This test is an assessment of the number of motile sperm per high-power microscopic field. d. This test is an evaluation of the interaction between the sperm and cervical mucus.

29. Which of the following tests is used to screen blood for antibody compatibility before a blood transfusion? a. Direct Coombs test b. Indirect Coombs test c. Complete blood cell count d. Serum haptoglobin test 30. Which of the following statements is false with regard to the semen analysis test? a. A single sperm analysis can be conclusive evidence of male infertility. b. Men with little or no sperm should be evaluated for pituitary, thyroid, adrenal, or testicular aberrations. c. A 2- to 3-day period of sexual abstinence is necessary before collection of the semen specimen. d. For best results, a semen sample should be collected in the physician’s office or laboratory by means of masturbation.

31. Which of the following tests is used to monitor warfarin administration? a. Activated partial thromboplastin time b. Platelet count c. Bleeding time d. International normalized ratio (INR) 32. Which of the following factors may cause an increase in hematocrit concentration? a. Hemorrhage b. Bone marrow failure c. Pregnancy d. Dehydration 33. A “shift to the left” in white blood cell production indicates an acute bacterial infection.

Which of the following cells are increased in this situation? a. Mature neutrophils b. Monocytes c. Lymphocytes d. Band (or stab) cells 34. The physician orders a blood culture for a patient with suspected bacteremia. Which of the following statements is incorrect with regard to the collection of this specimen? a. Blood culture specimens should be drawn at the time the patient has a fever or chills. b. If the patient is receiving antibiotics already, the laboratory should be notified, and the blood culture specimeN n shR ouldIbeGcolB le. ctC ed sM hortly before the next dose of U S N T O antibiotic is administered. c. Two culture specimens should be obtained and from different sites. d. The culture specimen can be drawn at any time without regard to medications and vital signs.

35. Which of the following is a possible cause of hyperkalemia? a. Diarrhea and vomiting b. Diuretic drug therapy c. Cushing’s syndrome d. Acidosis 36. After returning from an esophagogastroduodenoscopy (EGD) and dilation of an esophageal stricture, a patient began to complain of fever and chest pain. What should the nurse suspect, and what is the most appropriate action? a. Myocardial infarction, and obtaining electrocardiography (ECG) immediately b. Gastroesophageal reflux, and administering an antacid c. Esophageal perforation, and notifying the physician immediately d. Dyspepsia from not eating before the procedure, and allowing the patient to eat bland food

37. After undergoing a barium enema study, what instruction should patients be given? a. Take an oral laxative to completely evacuate the barium. b. Try to retain the barium in case additional radiographic studies are needed the same day or the following day. c. Await normal bowel function. d. None of the above.

38. After returning from colonoscopy, a patient complains of increasing abdominal pain.

What is an appropriate nursing intervention? a. Limiting her diet to clear liquids b. Assisting her with a warm bath to soothe the anorectal area c. Administering a gentle enema to assist in evacuation of colon contents and air d. Administering a laxative to assist in evacuation of excess colon contents e. None of the above 39. A woman in her first trimester of pregnancy develops pain consistent with gallbladder disease. What is the most appropriate diagnostic test? a. Gallbladder ultrasonography b. Gallbladder radioscintigraphy scan c. Oral cholecystography d. Computed tomography 40. After a liver biopsy, the patient should: y a. Ambulate to maintain mobNilitR b. Lie on the left side c. Lie on the right side d. Lie prone 41. A nurse has been stuck by a needle from a patient being treated for hepatitis. What is the most appropriate action or actions? a. Immediate enteric and blood product precautions to isolate the involved nurse b. Immediately obtaining hepatitis viral studies on the affected nurse c. Hospitalizing the nurse for bed rest d. All the above e. None of the above 42. A patient’s leg has become swollen 1 week after arthroscopy. For what should he be evaluated? a. Hemarthrosis b. Joint stiffness after prolonged immobilization c. Postoperative thrombophlebitis d. Joint dislocation

43. A 5-year-old patient has fallen and injured her right arm during play therapy. Why does the physician order radiographs of both arms? a. The noninjured arm could have been injured in the fall. b. Fracture lines of long bones in children are difficult to distinguish from normal growth lines, which make comparison films necessary. c. The battered child syndrome can be diagnosed by documenting multiple fractures. d. All the above.

44. A patient has just undergone diagnostic arthroscopy and has mild discomfort. Which of the following interventions is most appropriate? a. Ambulating the patient b. Notifying the physician c. Administering a mild analgesic (e.g., acetaminophen) d. Administering an intramuscular narcotic 45. What drug should be discontinued before the serum gastrin level is measured? a. Hydrochlorothiazide b. Propranolol (Inderal) c. Cimetidine (Tagamet) d. All the above 46. Which of the following instructions should the nurse give a client after an upper gastrointestinal study? chU alR kySI whNitG eT foB r. atCleasMt a day.” a. “Expect your stools to be N b. “Take a cathartic (such as milk of magnesia).” c. “Drink plenty of fluids when you get home.” d. All the above.

47. Which of the following test results would indicate a complication of endoscopic retrograde cholangiopancreatography (ERCP)? a. Red blood cells in the urine b. Elevated serum amylase level c. Elevated serum calcium level d. All the above 48. Carcinoembryonic antigen (CEA) is used to monitor patients with what condition? a. Colon cancer b. Breast cancer c. Gastric cancer d. All the above 49. Specific gravity in the urine is increased in patients with what condition? a. Dehydration b. Diabetes insipidus c. Chronic renal failure d. All the above

50. Intravenous pyelography (IVP) may be contraindicated in patients with what condition? a. Shellfish allergy b. Severe dehydration c. Renal insufficiency d. All the above 51. Immediately after undergoing kidney biopsy, a patient notices gross hematuria. What is the most appropriate nursing intervention? a. Collecting serial urine specimens b. Dehydrating the patient to diminish urine output and bleeding c. Notifying the physician immediately and obtaining a specimen for blood typing and crossmatching d. All the above 52. Which of the following foods may interfere with determining the results of urinary vanillylmandelic acid or catecholamines? a. Potatoes and red meat b. Coffee and licorice c. Beer and salted pretzels d. All the above 53. A “no added salt” diet is necessary for patients before which of the following studies? a. Urine specific gravity b. IVP c. Plasma renin assay d. Renal scanning 54. What is the most specific test for identifying recurrent prostate cancer? a. Prostatic acid phosphatase measurement b. Prostate-specific antigen (PSA) measurement c. Digital rectal examination d. Transrectal ultrasonography 55. A nurse should ask the patient which of the following questions before scheduling IVP? a. “Are you allergic to shellfish or iodine?” b. “Have you ever undergone IVP before?” c. “Are you able to drink a lot of fluids?” d. All the above

Practice Test

10

56. Before mammography, which of the following is or are appropriate information to give a patient? a. Mammography involves a low dose of radiation and therefore can safely be performed annually. b. Mammography can reveal breast cancer 1 to 2 years before a tumour is clinically palpable. c. Although mammography is an accurate means of detecting breast cancer, it is only 85% accurate. d. All the above.

57. What is the most accurate method of screening for breast cancer? a. MRI of the breast b. Mammography c. Ultrasonography of the breast d. Physical examination 58. Which of the following tumour markers is associated with breast cancer? a. Alpha-fetoprotein b. Human chorionic gonadotropin c. CA–15-3 d. CA-125

Pagana: Mosby's Canadian Manual of Diagnostic and Laboratory Tests, 1st Canadian Edition Practice Test Answer Key

1. Which of these instructions should a nurse give an elderly, dehydrated patient after computed tomography (CT) of the kidney with intravenous iodine contrast material? a. Drink plenty of fluids for 24 hours. b. Avoid heavy lifting for 2 days. c. Use a laxative to clear the contrast from the bowel. d. None of the above.

Answer: a Rationale: Elderly patients often are chronically dehydrated and therefore especially susceptible to renal impairment after receiving intravenous iodine contrast material. Not only is the use of laxatives unnecessary to eliminate the contrast material, but it will also further dehydrate the patient. No physical limitations are required.

Reference page: 1073 2. For a patient with severe bone destruction from tumour or osteomalacia, what serum laboratory results would the nurse expect to assess? a. Decreased serum alkaline phosphatase (ALP) level b. Increased serum ALP level NUentSatioNn raTte c. Decreased erythrocyte sedim d. Increased red blood cell count Answer: b Rationale: Patients with destructive bone diseases commonly have elevated ALP levels as a result of bone cell destruction and regeneration.

Reference page: 58 3. A patient’s laboratory reports indicate the presence of Bence-Jones proteins. These levels are increased in the urine of patients who have: a. Multiple myeloma b. Carcinoid syndrome c. Breast cancer d. Colorectal cancer Answer: a Rationale: Bence-Jones proteins are immunoglobulins that are commonly excreted in the urine of patients with multiple myeloma.

Reference page: 1025

4. A patient is admitted for evaluation of perforated diverticulitis. Which of the following is the most appropriate test? a. CT of the abdomen b. Barium enema c. Colonoscopy d. All the above Answer: a Rationale: CT is accurate for identifying an abdominal abscess. Colonoscopy and barium enema are contraindicated in patients with suspected perforated viscus.

Reference page: 1073 5. Blood urea nitrogen (BUN) levels may be abnormally low in which patients? a. Overly hydrated patients b. Patients with liver disease c. Malnourished patients in negative nitrogen balance d. All the above Answer: d Rationale: BUN levels can decrease normally in patients who are well hydrated.

Because liver function must be adequate to make urea, severe liver dysfunction is associated with decreased BUN levels. Because BUN also is a measure of protein nutrition, this level can be diminished in starving patients.

Reference page: 578 6. The serum creatinine level is usually elevated in patients with which of the following? a. Renal disease b. Liver disease c. Lung disease d. Muscular disease Answer: a Rationale: An elevated serum creatinine level indicates renal disease. No other diseased organ causes elevation of the serum creatinine level.

Reference page: 218 7. A patient presents with upper gastrointestinal bleeding from a suspected peptic ulcer.

Which of the following is the most appropriate test? a. Upper gastrointestinal radiography b. Gastric bleeding scan c. Esophagogastroduodenoscopy (EGD) d. None of the above Answer: c Rationale: EGD is the most accurate diagnostic test. Furthermore, transendoscopic coagulation of active bleeding can be performed with EGD. Reference page: 689

8. A patient is admitted with abdominal pain. Ultrasonography of the abdomen, CT of the abdomen, and a barium enema study have been ordered. In what order should these tests be performed? a. Ultrasonography, barium enema, CT b. Ultrasonography, CT, barium enema c. Barium enema, CT, ultrasonography d. CT, barium enema, ultrasonography Answer: b Rationale: Ultrasonography should be performed first because intraabdominal barium will distort the sound waves and thus decrease the accuracy. Also, if the ultrasonography of the abdomen includes water distension of the stomach, the patient will need to void before proceeding to CT to prevent discomfort. Likewise, barium within the bowel will distort the CT image. Therefore ultrasonography should be done first, CT second, and barium enema last.

Reference page: 971 9. A patient is scheduled for a cardiac exercise stress test to evaluate chest pain. While obtaining the patient history, the clinician notes that the patient has intermittent claudication when walking two blocks. On the basis of this finding, which of the following is indicated? a. The test will be performed as scheduled. b. The test is contraindicated because of the intermittent claudication. c. The test will be rescheduleNdUaR fteSrI reN soGluTtiB on.oCf thMe claudication. d. The patient is a candidate for the dipyridamole-thallium (nonexercise) stress test.

Answer: d Rationale: The patient’s peripheral vascular disease will cause calf pain during exercise.

This pain probably will precede exercise-induced chest pain and cause the test to be terminated prematurely.

Reference page: 607 10. A patient is scheduled for a cardiac catheterization. Which of the following activities is a postprocedure nursing priority? a. Ambulating the patient b. Encouraging coughing and deep-breathing exercises c. Keeping the patient on NPO status (nothing by mouth) d. Keeping the involved extremity immobilized Answer: d Rationale: The extremity in which the catheter was placed must be kept straight and immobilized for several hours after catheterization to prevent bleeding. Ice packs may minimize any swelling or hematoma at the catheter insertion site.

Reference page: 1141

11. One of the blood studies used to detect a myocardial infarction is creatine kinase (CK).

What value is most helpful for diagnosing a myocardial infarction? a. Total CK b. Isoenzyme CK-MM c. Isoenzyme CK-MB d. Isoenzyme CK-BB Answer: c Rationale: The isoenzyme CK-MB provides a unique marker for damaged myocardial cells.

Reference page: 214 12. During a patient’s exercise stress test, his blood pressure dropped. Which of the following activities should be avoided in the 2-hour period after the test? a. Walking b. Taking a hot shower c. Eating a light meal d. Resting in his bed Answer: b Rationale: A hot shower may cause an increase in cutaneous vasodilation and lead to orthostatic hypotension.

Reference page: 607 13. A patient had a lipid profile dN ocU um ReSnIteN dG anTdBa. skC s abM out her results. Which of the following is considered the ideal high-density lipoprotein (HDL)/total cholesterol ratio? a. 1:2 b. 1:3 c. 1:4 d. 1:5 Answer: b Rationale: The ideal ratio of HDL/total cholesterol is 1:3. An acceptable ratio is at least 1:5.

Reference page: 383 14. A patient underwent a tuberculin skin test 48 hours ago. He returns to the clinic for the nurse to read the test results. Which of the following is considered a positive result? a. A reddened area measuring 20 mm b. A flat, red area measuring 10 mm c. An indurated area measuring 8 mm d. An indurated area measuring 12 mm Answer: d Rationale: An indurated (hardened) area measuring more than 10 mm is a positive result.

This means that the patient has been exposed to tuberculosis.

Reference page: 1279

15. A patient with diabetes was taken to the emergency department. His arterial blood gas results were as follows: pH: 7.25 Partial pressure of carbon dioxide (PCO2): 38 mm Hg HCO3- 19 mmol/L Partial pressure of oxygen (PO2): 95 mm Hg What do these results indicate? a. Respiratory acidosis b. Respiratory alkalosis c. Metabolic acidosis d. Metabolic alkalosis Answer: c Rationale: The pH indicates acidosis. The lower HCO3- value indicates a metabolic problem.

Reference page: 127 16. A patient has just returned from the endoscopy suite, where he underwent bronchoscopy.

Which of the following is not a nursing priority after the procedure? a. Observing the sputum for hemorrhage b. Monitoring the vital signs frequently c. Observing the patient closely for laryngospasm d. Encouraging cool fluids to comfort his throat Answer: d Rationale: The patient is kept on NPO status until the tracheobronchial anaesthesia has worn off and the gag reflex has returned. This usually occurs within 2 hours. A patient who drinks or eats before this time could aspirate and develop pneumonia.

Reference page: 664 17. What is the best time of the day for obtaining a sputum specimen? a. Early morning b. After breakfast c. Evening d. The time does not matter Answer: a Rationale: Obtaining an early-morning specimen is best because secretions pool and collect in the lungs during sleep.

Reference page: 864

18. A patient is scheduled for magnetic resonance imaging (MRI). Which of the following factors is a contraindication to this procedure? a. Iodine allergy b. Severe visual impairment c. Cardiac pacemaker d. None of the above Answer: c Rationale: An implantable metal pacemaker is a contraindication for this procedure because the magnet may move the object within the body and cause damage.

Reference page: 1256 19. Which of the following activities should be avoided before electroencephalography (EEG)? a. Washing the hair the night before the procedure b. Taking anticonvulsant medications c. Drinking caffeinated fluids such as regular coffee, tea, or cola d. None of the above Answer: c Rationale: Regular coffee, tea, and cola are not permitted on the morning of the study because of their stimulating effect.

Reference page: 619 20. After a lumbar puncture, a nuN rsiU nR g pSrI iorN itG yT isBto.pCrevM ent a spinal headache. Which of the following activities is to be avoided? a. Ambulating the patient in the room b. Drinking fluids through a straw c. Keeping the patient on bed rest d. Keeping the patient’s head flat Answer: a Rationale: Walking immediately after lumbar puncture may induce a headache. It is best for the patient to remain in bed at rest for about 30 minutes.

Reference page: 735 21. A patient is scheduled for lumbar puncture. Which of the following conditions is a contraindication to this procedure? a. Meningitis b. Neurosyphilis c. Multiple sclerosis d. Increased intracranial pressure (ICP) Answer: d Rationale: Patients with increased ICP cannot undergo lumbar puncture because the lumbar puncture may induce cerebral or cerebellar herniation.

Reference page: 735

22. Which of the following statements regarding a glycosylated hemoglobin test is false? a. The test provides an accurate long-term index of the patient’s average blood glucose level. b. The test aids in determining the duration of hyperglycemia in a patient with newly diagnosed diabetes. c. No fasting is required for this test. d. Short-term physiologic variations (e.g., those caused by food intake, exercise, and stress) affect the test result.

Answer: d Rationale: An advantage of this test is that the blood sample can be drawn at any time because glycosylated hemoglobin is not affected by short-term physiologic variations.

Reference page: 301 23. A patient has an elevated glucose level. Which of the following factors in his history may cause hyperglycemia? a. Insulinoma b. Corticosteroid therapy c. Hypothyroidism d. Addison’s disease Answer: b Rationale: Corticosteroid therapy causes chemically induced diabetes.

Reference page: 286 24. Cortisol levels normally rise and fall during the day. This fluctuation is referred to as the diurnal variation. At what time of the day are levels the highest? a. 8 am b. Noon c. 4 pm d. Midnight Answer: a Rationale: Cortisol levels are highest at approximately 6 AM to 8 AM and gradually fall during the day to the lowest point near midnight.

Reference page: 204 25. Symptoms that may indicate hypocalcemia include which of the following? a. Nausea, vomiting, and anorexia b. Polyuria and dehydration c. Muscle weakness and coma d. Tetany and carpal pedal spasms

Answer: d Rationale: Symptoms such as tetany and carpal pedal spasms indicate the need for a calcium level test to rule out hypocalcemia. Nausea, vomiting, anorexia, and confusion are signs of hypercalcemia.

Reference page: 159 26. A patient has been diagnosed with primary hypothyroidism. Her triiodothyronine (T3) and thyroxine (T4) levels are decreased. What would a clinician expect the thyroidstimulating hormone (TSH) levels to be? a. Normal b. Increased c. Decreased d. Near zero Answer: b Rationale: Low levels of T3 and T4 are the underlying stimuli for TSH elevation.

Therefore, in primary hypothyroidism, a compensatory elevation of TSH level occurs.

Reference page: 535 27. Often during a fetal nonstress test (fetal activity determination test), fetal activity must be stimulated. Which of the following stimuli is not part of this test? a. Rubbing the mother’s abdomen b. Administering intravenous oxytocin c. Ringing a bell near the abdomen d. Compressing the mother’sNaU bdRoS mI enN Answer: b Rationale: Oxytocin administration is not used in the nonstress test. It is part of the contraction stress test (oxytocin challenge test).

Reference page: 642 28. Which of the following statements best describes the Sims-Huhner test? a. This test is an evaluation of the quality of cervical mucus. b. This test is an examination of cervical mucus for colour, viscosity, and tenacity. c. This test is an assessment of the number of motile sperm per high-power microscopic field. d. This test is an evaluation of the interaction between the sperm and cervical mucus.

Answer: d Rationale: Options a, b, and c are all performed as part of this test. However, this test is mainly used as a postcoital examination of the cervical mucus to determine the ability of the sperm to penetrate the mucus and maintain mobility.

Reference page: 763

29. Which of the following tests is used to screen blood for antibody compatibility before a blood transfusion? a. Direct Coombs test b. Indirect Coombs test c. Complete blood cell count d. Serum haptoglobin test Answer: b Rationale: The indirect Coombs test is used to determine whether the patient has antibodies to the red blood cell that he or she is about to receive by blood transfusion.

Reference page: 202 30. Which of the following statements is false with regard to the semen analysis test? a. A single sperm analysis can be conclusive evidence of male infertility. b. Men with little or no sperm should be evaluated for pituitary, thyroid, adrenal, or testicular aberrations. c. A 2- to 3-day period of sexual abstinence is necessary before collection of the semen specimen. d. For best results, a semen sample should be collected in the physician’s office or laboratory by means of masturbation.

Answer: a Rationale: Because the sperm count varies from day to day, a single sperm analysis is inconclusive, especially if it indicates infertility.

Reference page: 757 31. Which of the following tests is used to monitor warfarin administration? a. Activated partial thromboplastin time b. Platelet count c. Bleeding time d. International normalized ratio (INR) Answer: d Rationale: To have uniform standards of prothrombin time results throughout the world, those results now include the INR value.

Reference page: 482 32. Which of the following factors may cause an increase in hematocrit concentration? a. Hemorrhage b. Bone marrow failure c. Pregnancy d. Dehydration Answer: d Rationale: Dehydration causes the hematocrit value to be artificially high.

Reference page: 317

33. A “shift to the left” in white blood cell production indicates an acute bacterial infection.

Which of the following cells are increased in this situation? a. Mature neutrophils b. Monocytes c. Lymphocytes d. Band (or stab) cells Answer: d Rationale: Band, or stab, cells are immature forms of neutrophils that enter the circulation during an acute bacterial infection.

Reference page: 591 34. The physician orders a blood culture for a patient with suspected bacteremia. Which of the following statements is incorrect with regard to the collection of this specimen? a. Blood culture specimens should be drawn at the time the patient has a fever or chills. b. If the patient is receiving antibiotics already, the laboratory should be notified, and the blood culture specimen should be collected shortly before the next dose of antibiotic is administered. c. Two culture specimens should be obtained and from different sites. d. The culture specimen can be drawn at any time without regard to medications and vital signs.

Answer: d Rationale: Specimens shouldNbU eR coS llI ecN teG dT asBi. ndCicatM ed in options a, b, and c.

Reference page: 804 35. Which of the following is a possible cause of hyperkalemia? a. Diarrhea and vomiting b. Diuretic drug therapy c. Cushing’s syndrome d. Acidosis Answer: d Rationale: Acidotic states tend to raise serum potassium levels by causing a shift of potassium out of the cell. All the other options (a, b, and c) are causes of hypokalemia.

Reference page: 453 36. After returning from an esophagogastroduodenoscopy (EGD) and dilation of an esophageal stricture, a patient began to complain of fever and chest pain. What should the nurse suspect, and what is the most appropriate action? a. Myocardial infarction, and obtaining electrocardiography (ECG) immediately b. Gastroesophageal reflux, and administering an antacid c. Esophageal perforation, and notifying the physician immediately d. Dyspepsia from not eating before the procedure, and allowing the patient to eat bland food

Answer: c Rationale: Esophageal perforation is a complication associated with EGD, especially when the esophagus has been dilated. The nurse should notify the physician immediately, keep the patient on NPO status, maintain intravenous access, and record vital signs.

Reference page: 689 37. After undergoing a barium enema study, what instruction should patients be given? a. Take an oral laxative to completely evacuate the barium. b. Try to retain the barium in case additional radiographic studies are needed the same day or the following day. c. Await normal bowel function. d. None of the above.

Answer: a Rationale: A laxative should be provided to the patient to evacuate retained barium, which may cause an impaction. Stool will be light in colour until all barium has been expelled.

Reference page: 1124 38. After returning from colonoscopy, a patient complains of increasing abdominal pain.

What is an appropriate nursing intervention? a. Limiting her diet to clear liquids b. Assisting her with a warm bath to soothe the anorectal area c. Administering a gentle enema to assist in evacuation of colon contents and air d. Administering a laxative tN oU asR siS stI inNeG vaTcB ua.tiC onOoMf excess colon contents e. None of the above Answer: e Rationale: Bowel perforation should be suspected. The patient should be kept on NPO status, and intravenous access should be maintained. The physician should be notified immediately and vital signs monitored.

Reference page: 670 39. A woman in her first trimester of pregnancy develops pain consistent with gallbladder disease. What is the most appropriate diagnostic test? a. Gallbladder ultrasonography b. Gallbladder radioscintigraphy scan c. Oral cholecystography d. Computed tomography Answer: a Rationale: This is the only test that does not expose the fetus to potentially harmful radiation.

Reference page: 971

40. After a liver biopsy, the patient should: a. Ambulate to maintain mobility b. Lie on the left side c. Lie on the right side d. Lie prone Answer: c Rationale: If the patient lies on the right side, the liver capsule is compressed against the chest wall, creating a tamponade for any hemorrhage or bile leak that may occur.

Reference page: 834

41. A nurse has been stuck by a needle from a patient being treated for hepatitis. What is the most appropriate action or actions? a. Immediate enteric and blood product precautions to isolate the involved nurse b. Immediately obtaining hepatitis viral studies on the affected nurse c. Hospitalizing the nurse for bed rest d. All the above e. None of the above Answer: e Rationale: Enteric precautions isolating the nurse will not help because the hepatitis B and C viruses are bloodborne. Hepatitis viral tests do not yield positive results for 2 to 12 weeks after exposure. Hospitalization and bed rest are not required for cases of hepatitis exposure.

Reference page: 328 42. A patient’s leg has become swollen 1 week after arthroscopy. For what should he be evaluated? a. Hemarthrosis b. Joint stiffness after prolonged immobilization c. Postoperative thrombophlebitis d. Joint dislocation Answer: c Rationale: Thrombophlebitis is a complication associated with arthroscopy and usually occurs 5 to 10 days after surgery.

Reference page: 661 43. A 5-year-old patient has fallen and injured her right arm during play therapy. Why does the physician order radiographs of both arms? a. The noninjured arm could have been injured in the fall. b. Fracture lines of long bones in children are difficult to distinguish from normal growth lines, which make comparison films necessary. c. The battered child syndrome can be diagnosed by documenting multiple fractures. d. All the above.

Answer: b Rationale: Fracture lines of long bones in children often are difficult to distinguish on radiographic film from normal growth lines. Any line suspected of representing a fracture that is seen on both arms is not a fracture. It merely represents a normal growth pattern in the young child. However, such lines that are unilateral are considered fractures until proven otherwise.

Reference page: 1139 44. A patient has just undergone diagnostic arthroscopy and has mild discomfort. Which of the following interventions is most appropriate? a. Ambulating the patient b. Notifying the physician c. Administering a mild analgesic (e.g., acetaminophen) d. Administering an intramuscular narcotic Answer: c Rationale: For mild discomfort after diagnostic arthroscopy, a mild analgesic usually controls the pain.

Reference page: 661 45. What drug should be discontinued before the serum gastrin level is measured? a. Hydrochlorothiazide b. Propranolol (Inderal) c. Cimetidine (Tagamet) d. All the above Answer: c Rationale: Cimetidine is a histamine antagonist, which diminishes gastric acid secretion.

The normal physiologic feedback mechanism factitiously elevates serum gastrin levels.

Reference page: 280 46. Which of the following instructions should the nurse give a client after an upper gastrointestinal study? a. “Expect your stools to be chalky white for at least a day.” b. “Take a cathartic (such as milk of magnesia).” c. “Drink plenty of fluids when you get home.” d. All the above.

Answer: d Rationale: After any barium contrast study, the nurse should recommend that the client use a laxative and drink plenty of fluids to help eliminate barium.

Reference page: 1222

47. Which of the following test results would indicate a complication of endoscopic retrograde cholangiopancreatography (ERCP)? a. Red blood cells in the urine b. Elevated serum amylase level c. Elevated serum calcium level d. All the above Answer: b Rationale: A known complication of ERCP is pancreatitis after injection of contrast material into the pancreatic duct. An elevated amylase level is diagnostic.

Reference page: 685 48. Carcinoembryonic antigen (CEA) is used to monitor patients with what condition? a. Colon cancer b. Breast cancer c. Gastric cancer d. All the above Answer: d Rationale: Levels of CEA can be abnormal in patients with various carcinomas (e.g., gastrointestinal and breast carcinomas). Also, many benign diseases (e.g., diverticulitis, ulcerative colitis, and cirrhosis) may be associated with moderate elevations in CEA level.

Reference page: 167 49. Specific gravity in the urine is increased in patients with what condition? a. Dehydration b. Diabetes insipidus c. Chronic renal failure d. All the above Answer: a Rationale: Because the kidneys are reabsorbing all available free water, the excreted urine is concentrated. The urine is dilute in patients with diabetes insipidus and chronic renal failure.

Reference page: 1073 50. Intravenous pyelography (IVP) may be contraindicated in patients with what condition? a. Shellfish allergy b. Severe dehydration c. Renal insufficiency d. All the above

Answer: d Rationale: Patients who are allergic to shellfish also can be allergic to iodine. Severely dehydrated patients can go into renal failure with iodine injection. Kidney function, when already diminished, can deteriorate with iodine injection.

Reference page: 1178 51. Immediately after undergoing kidney biopsy, a patient notices gross hematuria. What is the most appropriate nursing intervention? a. Collecting serial urine specimens b. Dehydrating the patient to diminish urine output and bleeding c. Notifying the physician immediately and obtaining a specimen for blood typing and crossmatching d. All the above Answer: a Rationale: After a kidney biopsy, it is not unusual for the patient to have hematuria for the first 24 hours. Urine samples may be collected in consecutive chronologic order to facilitate comparison for evaluation of hematuria. These are referred to as rack, or serial, urine samples.

Reference page: 852 52. Which of the following foods may interfere with determining the results of urinary vanillylmandelic acid or catecholamines? a. Potatoes and red meat b. Coffee and licorice c. Beer and salted pretzels d. All the above Answer: b Rationale: For patients in whom a 24-hour urine specimen is collected for assessment of vanillylmandelic acid or catecholamines, foods that generally should be restricted include coffee, tea, bananas, chocolate, licorice, citrus fruits, vanilla, and aspirin.

Reference page: 1095 53. A “no added salt” diet is necessary for patients before which of the following studies? a. Urine specific gravity b. IVP c. Plasma renin assay d. Renal scanning Answer: c Rationale: A high intake of sodium can cause a decrease in levels of plasma renin.

Reference page: 498

54. What is the most specific test for identifying recurrent prostate cancer? a. Prostatic acid phosphatase measurement b. Prostate-specific antigen (PSA) measurement c. Digital rectal examination d. Transrectal ultrasonography Answer: b Rationale: PSA measurement is more sensitive and more specific for recurrent prostate cancer than are other tumour markers. Because recurrence may develop outside the pelvis, digital rectal examination and transrectal ultrasonography would not identify recurrences in other locations.

Reference page: 468 55. A nurse should ask the patient which of the following questions before scheduling IVP? a. “Are you allergic to shellfish or iodine?” b. “Have you ever undergone IVP before?” c. “Are you able to drink a lot of fluids?” d. All the above Answer: d Rationale: Patients who are allergic to shellfish or iodine will have an allergic reaction to the contrast material used during IVP. Having undergone IVP previously without a reaction eliminates the possibility of serious anaphylactic reaction to the dye. Patients must be able to adequately hydrate themselves before and after administration of intravenous iodine to avoid suN bsU eR quS eI nt N reGnaTlB im .pCairm Ment.

Reference page: 1178 56. Before mammography, which of the following is or are appropriate information to give a patient? a. Mammography involves a low dose of radiation and therefore can safely be performed annually. b. Mammography can reveal breast cancer 1 to 2 years before a tumour is clinically palpable. c. Although mammography is an accurate means of detecting breast cancer, it is only 85% accurate. d. All the above.

Answer: d Rationale: All the remarks concerning mammography are accurate.

Reference page: 1187 57. What is the most accurate method of screening for breast cancer? a. MRI of the breast b. Mammography c. Ultrasonography of the breast d. Physical examination

Practice Test Answer Key

17

Answer: b Rationale: Ultrasonography and physical examination have an accuracy level inferior to that of mammography. MRI is more sensitive than mammography, but its poor specificity (too many false-positive results) limits its use as a screening tool.

Reference page: 1209 58. Which of the following tumour markers is associated with breast cancer? a. Alpha-fetoprotein b. Human chorionic gonadotropin c. CA–15-3 d. CA-125 Answer: c Rationale: CA–15-3 is specific to breast cancer. CEA and CA–27-29 are other tumour markers that are helpful in the evaluation of a patient with breast cancer.

Reference page: 152

Review Questions Cancer 1. Question: A 36-year-old patient indicates that she wants both of her breasts removed because of a strong family history of breast cancer. Her mother developed breast cancer at age 45 and died of that disease at age 50. Her older sister is now dying of breast cancer at age 44. The patient has two young daughters and does not want to risk dying before her children grow up. What advice should the nurse give her?

2. Question: A 48-year-old patient is concerned about the radiation exposure risk associated with mammography. She would like to undergo breast scintigraphy instead. What advice should the nurse give her?

3. Question: During a routine evaluation, a patient is found to have a suspect lesion on mammography. Her physical examination results are negative, and she has no palpable masses. Should a biopsy of this mass be performed?

4. Question: The patient is a 56-year-old woman who had a colon cancer removed 2 years ago. Her carcinoembryonic antigen (CEA) level is now 4.2 mcg/L. Is this N R I G B.C M significant?

5. Question: A 62-year-old patient is admitted to the hospital for melanoma. During his staging workup, a bone scan is performed. The bone scan is normal except for a “hot spot” in the right rib. What might have caused this abnormality?

6. Question: A 22-year-old female patient complains of right upper quadrant abdominal pain. Gallbladder ultrasonography and upper gastrointestinal endoscopy are performed, and the results are negative. A liver-spleen scan indicates a filling defect in the anterior surface of the liver. Does this indicate a liver tumour?

7. Question: A patient with a diagnosis of pancreatic cancer has recently been admitted to the hospital with a rapid onset of ascites. She is extremely uncomfortable and anxious to institute treatment for this symptom. The nurse is aware that the CA 19-9 tumour marker tests have been performed. What is the purpose of the CA 19-9 marker and how could it influence care?

Review Questions Answer Key Cancer 1. Question: A 36-year-old patient indicates that she wants both of her breasts removed because of a strong family history of breast cancer. Her mother developed breast cancer at age 45 and died of that disease at age 50. Her older sister is now dying of breast cancer at age 44. The patient has two young daughters and does not want to risk dying before her children grow up. What advice should the nurse give her?

Answer: This woman does have a significant family history of breast cancer and may have a breast cancer antigen (BRCA) genetic defect. If appropriate, the nurse should provide information on how the patient and her sister could be tested for the BRCA gene. If the test is positive, further genetic consultation is required. It is important to inform the BRCA-negative patient that her risk is still similar to that of the general public.

Reference page: 1140 2. Question: A 48-year-old patient is concerned about the radiation exposure risk associated with mammography. She would like to undergo breast scintigraphy NUthe RSnur INseGgTive B.C instead. What advice should herO ?

Answer: Mammography is an X-ray examination of the breast that is performed with exposure to approximately 0.5 rad of radiation per view. Scintigraphy involves an injection of an intravenous radionuclide and the use of a gamma ray scintigraphy camera to pass over the breasts and record radioactive uptake or “hot” or “cold” spots. Because the amount of radionuclide used in scintigraphy is small, there is a relatively low risk of radiation exposure; however, mammography has an even lower risk of radiation exposure than scintigraphy.

Reference page: 1088 3. Question: During a routine evaluation, a patient is found to have a suspect lesion on mammography. Her physical examination results are negative, and she has no palpable masses. Should a biopsy of this mass be performed?

Answer: Mammography can be used to locate a mammographically identified (i.e., not palpable) lesion for biopsy, but follow up is required. It is important to inform the patient that further testing is not uncommon after a mammograph. If the radiologist sees something that should be more thoroughly evaluated with magnified views, deeper views, or ultrasonography, the patient may be called back for further testing, prior to performing a biopsy.

Reference page: 1088

4. Question: The patient is a 56-year-old woman who had a colon cancer removed 2 years ago. Her carcinoembryonic antigen (CEA) level is now 4.2 mcg/L. Is this significant?

Answer: This patient’s CEA level is elevated, but not above normal. This test is used in the surveillance of patients with cancer. A steadily rising CEA level is occasionally the first sign of tumour recurrence. Therefore, CEA testing is very valuable in the follow-up of patients who have already had potentially curative therapy. However, many (∼20%) patients with advanced breast or gastrointestinal tumours may not have elevated CEA levels. Without knowing this patient’s prior CEA levels, it is not certain that the level represents recurrent disease. However, if continued monitoring reveals a rising CEA level on successive tests, it may be indicative of cancer recurring in this patient.

Reference page: 160 5. Question: A 62-year-old patient is admitted to the hospital for melanoma. During his staging workup, a bone scan is performed. The bone scan is normal except for a “hot spot” in the right rib. What might have caused this abnormality?

Answer: Increased uptake on a bone scan, or hot spots, may indicate areas of osteoblastic or new bone growth around areas, or abnormality such as a tumour, arthritis, or injury. Hot spots can be caused by many factors including tumour metastatic to the bone, an old healed fracture, arthritis, or benign bone disease. In this case, radiography of the riN b wR , aCnd M an old healed rib fracture was UasSpIerfo NGrme TBd. identified. According to a more accurate history from the patient, he had fallen several years ago and had severe pain in that area for more than 2 weeks. This history is compatible with a previous fracture of the rib.

Reference page: 810 6. Question: A 22-year-old female patient complains of right upper quadrant abdominal pain. Gallbladder ultrasonography and upper gastrointestinal endoscopy are performed, and the results are negative. A liver-spleen scan indicates a filling defect in the anterior surface of the liver. Does this indicate a liver tumour?

Answer: No. Many diseases can produce an abnormal liver scan such as this. Benign tumours (e.g., adenomas, cysts, congenital abnormalities) can cause such an appearance. Computed tomography should be performed to eliminate the possibility of a cyst. CT-guided liver biopsies also can be performed to elucidate more clearly the cause of this abnormal liver scan. If these procedures fail to resolve the problem, peritoneoscopy with actual visualization of that portion of the liver can be performed.

Reference page: 836 7. Question: A patient with a diagnosis of pancreatic cancer has recently been admitted to the hospital with a rapid onset of ascites. She is extremely uncomfortable and anxious to institute treatment for this symptom. The nurse is aware that the CA 19-9 tumour marker tests have been performed. What is the purpose of the CA 19-9

marker and how could it influence care?

Answer: CA 19-9 antigen is a tumour marker used for the diagnosis of pancreatic or hepatobiliary cancer, evaluation of response to treatment, and surveillance. If the CA 19-9 level is greatly elevated in this patient, it could indicate the presence of a pancreatic mass or biliary obstruction which would help to explain the ascites. A rapid rise in CA 19-9 levels could also be associated with recurrent or progressive tumour growth resulting in a shift of fluids and abdominal ascites. The CA 19-9 marker could help to determine the cause of the ascites and thus influence medical or surgical care.

Reference page: 145

Review Questions Cardiovascular System 1. Question: A patient has just returned from an appointment with her physician and asks you to help her understand her lipoprotein report. She does not understand why she needs to increase her high-density lipoprotein (HDL) level and decrease her low-density lipoprotein (LDL) level. What should you tell her?

2. Question: A patient is scheduled for transesophageal echocardiography (TEE). Despite the fact that he was instructed to remain on NPO status (nothing by mouth) for 4 to 6 hours before the test, the nurse finds him eating a sandwich 20 minutes before the test.

He tells you he was allowed to eat before echocardiography several years ago. What should the nurse do?

3. Question: The physician has requested electrocardiography (ECG) for a 66-year-old female patient complaining of undiagnosed central chest pain. The patient asks what the purpose of the ECG is. What should the nurse know about ECGs? 4. Question: While observing the cardiac monitors, the nurse in the coronary care unit sees NU RS GTshould B.CObeMthe nurse’s immediate reaction? a straight line for one of the pat ient s. I WNhat 5. Question: A patient has returned from undergoing a cardiac catheterization performed through the right radial artery. The patient begins to complain of right-arm pain, weakness, and tingling in the right hand. The nurse assesses the patient and finds a large hematoma over the right radial artery. The hand is pale and cooler than the left but has a faint pulse. What are the appropriate nursing interventions?

6. Question: A patient is admitted for an evaluation of increasingly frequent chest pains. In a review of other system complaints, the nurse finds that the patient has bilateral calf pain when walking two blocks (intermittent claudication). One of the studies ordered for this patient is a cardiac stress test. Can the nurse expect this patient to be able to complete this test?

7. Question: What is the purpose of determining the oxygen content in the blood obtained from the heart chambers during the cardiac catheterization of a pediatric patient experiencing a ventricular septal defect?

8. Question: Using the Framingham Heart Study, estimate the 10-year risk of nonfatal myocardial infarction (MI) or coronary death in a 44-year-old female patient with a total cholesterol level of 5.10 mmol/L, HDL 1.22 mmol/L, blood pressure untreated 132/90 mm Hg and a smoker. What advice would you give this patient?

Review Questions Answer Key Cardiovascular System 1. Question: A patient has just returned from an appointment with her physician and asks you to help her understand her lipoprotein report. She does not understand why she needs to increase her high-density lipoprotein (HDL) level and decrease her low-density lipoprotein (LDL) level. What should you tell her?

Answer: Nearly 75% of cholesterol is bound to LDL, and 25% is bound to HDL. It is the LDL that is most directly associated with increased risk for coronary heart disease (CHD). The nurse should explain to the patient that HDL is often called the “good cholesterol” because it removes cholesterol from the tissues and transports it to the liver for excretion. On the other hand, LDL is often called the “bad cholesterol” because it carries cholesterol and deposits it into the peripheral tissues.

Reference page: 356 2. Question: A patient is scheduled for transesophageal echocardiography (TEE). Despite the fact that he was instructed to remain on NPO status (nothing by mouth) for 4 to 6 hours before the test, the nurse finds him eating a sandwich 20 minutes before the test.

N R IreGeT B.Ciography M He tells you he was allowed to eUat bSefoN chocardO several years ago. What should the nurse do?

Answer: Ask the patient to describe his previous echocardiogram. Most likely it was obtained through transthoracic echocardiography (TTE), which does not require fasting.

Because the TEE requires inserting an endoscope through the mouth and into the esophagus, he should have remained on NPO status. Because he is at high risk for gagging and aspiration, the test should be postponed.

Reference page: 929 3. Question: The physician has requested electrocardiography (ECG) for a 66-year-old female patient complaining of undiagnosed central chest pain. The patient asks what the purpose of the ECG is. What should the nurse know about ECGs? Answer: Through the analysis of these wave forms and time intervals on the ECG, valuable information about the heart may be obtained. The ECG is used primarily to identify abnormal heart rhythms (arrhythmias, or dysrhythmias) and to diagnose acute myocardial infarction, conduction defects, and ventricular hypertrophy. Of importance is that the ECG may be normal, even in the presence of heart disease, if the heart disorder does not affect the electrical activity of the heart. You should explain that the purpose of the test is to find out if the chest pain is coming from the heart muscle.

Reference page: 568

4. Question: While observing the cardiac monitors, the nurse in the coronary care unit sees a straight line for one of the patients. What should be the nurse’s immediate reaction?

Answer: Sometimes mechanical failure or a misplaced lead can cause the cardiac monitor to display a straight or flat line instead of the patient’s normal heartbeat.

Nevertheless, the possibility exists that the patient’s heart has stopped. Therefore, before notifying the appropriate personnel involved in cardiac resuscitation, the nurse should go immediately to the patient’s room and assess the patient for signs of cardiac arrest.

Reference page: 571 5. Question: A patient has returned from undergoing a cardiac catheterization performed through the right radial artery. The patient begins to complain of right-arm pain, weakness, and tingling in the right hand. The nurse assesses the patient and finds a large hematoma over the right radial artery. The hand is pale and cooler than the left but has a faint pulse. What are the appropriate nursing interventions?

Answer: The nurse should reassure the patient and notify the physician immediately.

Continue to assess the patient’s extremities for signs of loss of blood supply (e.g., loss of pulses, numbness, pallor, tingling, pain, loss of sensory or motor function). Note and compare the colour and temperature of the involved extremity with that of the uninvolved extremity.

Reference page: 1052 edUfR orSaI nN evG aT luB ati. onCO ofMincreasingly frequent chest pains. In 6. Question: A patient is admittN a review of other system complaints, the nurse finds that the patient has bilateral calf pain when walking two blocks (intermittent claudication). One of the studies ordered for this patient is a cardiac stress test. Can the nurse expect this patient to be able to complete this test?

Answer: A cardiac stress test assesses the ability of patient to obtain and maintain a maximal heart rate of 85% for their predicted age and gender, with no cardiac symptoms or electrocardiographic change. If the patient has bilateral calf pain when walking two blocks, it would be anticipated they might not be able to reach their maximal heart rate because of their calf pain. The patient may be a candidate for chemical stress testing.

Reference page: 566 7. Question: What is the purpose of determining the oxygen content in the blood obtained from the heart chambers during the cardiac catheterization of a pediatric patient experiencing a ventricular septal defect?

Answer: As the cardiac catheter passes through the heart chambers, blood samples can be taken to analyze oxygen content. This helps to determine the presence and degree of congenital cardiac abnormalities, such as transposition of the great vessels, patent ductus arteriosus, and anomalous venous return to the heart. It can also assist with evaluating the severity of acquired and congenital cardiac valvular or septal defects.

Reference page: 1048

8. Question: Using the Framingham Heart Study, estimate the 10-year risk of nonfatal myocardial infarction (MI) or coronary death in a 44-year-old female patient with a total cholesterol level of 5.10 mmol/L, HDL 1.22 mmol/L, blood pressure untreated 132/90 mm Hg and a smoker. What advice would you give this patient?

Answer: Current Age (3 points) + cholesterol (3 points) + HDL (1 point) + systolic (2 points) + smoker (7 points) = 16. This patient has a 4% risk over the next 10 years of having a nonfatal MI or experiencing coronary death. The best advice would be to stop smoking, which would reduce her risk to only 1%.

Reference page: 172

Review Questions Endocrine System 1. Question: A 26-year-old female patient is a newly diagnosed type II diabetic and her current A1c (HbA1c) is 8%. How should a nurse approach this patient with regard to teaching her how to properly monitoring her diabetes?

2. Question: On return from adrenal venography, a patient’s blood pressure is 240/130 mm Hg, the heart rate is 144 beats per minute, and the respiration rate is 42 breaths per minute. What might be developing, and what are the appropriate interventions?

3. Question: A patient is scheduled to undergo a thyroid scan. While obtaining a medical history of the patient, the nurse learns that the patient is receiving thyroid replacement therapy and has taken his medication today. What are the implications of this? Should the thyroid scan be cancelled?

4. Question: On a routine evaluation for lower back pain, a 54-year-old woman is found to have hypocalcemia. Her serum parathyroid hormone (PTH) intact (whole) level is 72 ng/L. What might be the cause of this patient’s high PTH?

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5. Question: A patient who has a suspected adrenal tumour returns to the nursing unit after undergoing adrenal angiography. Physical assessment of the patient reveals that blood pressure is 280/140 mm Hg, pulse rate is 145 beats per minute, oral temperature is 101°F, and respiration rate is 38 breaths per minute. Is this patient having an allergic reaction to the dye?

6. Question: A male patient is scheduled for a 24-hour urine collection for a 17-ketosteroid (17-KS) test. During the nurse’s assessment the patent reports that he is currently taking antibiotics for a urinary tract infection. Will this affect the test? What advice would the nurse give this patient?

7. Question: A patient is undergoing a glucose tolerance test (GTT). Thirty minutes after ingestion of the glucose, the patient vomits. What should be done?

8. Question: A patient is admitted to the hospital for evaluation of signs and symptoms suggestive of Cushing’s syndrome. The physician has requested that the nurse begin collecting a 24-hour urine specimen for a 17-hydroxycorticosteroid (17-OCHS) test. In the initial assessment of the patient, the nurse finds that the patient has a severe infection of the upper respiratory tract. Should the test be performed?

Review Questions Answer Key Endocrine System 1. Question: A 26-year-old female patient is a newly diagnosed type II diabetic and her current A1c (HbA1c) is 8%. How should a nurse approach this patient with regard to teaching her how to properly monitoring her diabetes?

Answer: Explain to the patient that this test is used to monitor diabetes treatment and it provides an accurate long-term index of the patient’s average blood glucose level over the past 100 to 120 days. Her current result of 8% indicates that her diabetes is in fair control, but this could be improved. Discuss strategies for controlling HbA1c, such as diet.

Reference page: 281 2. Question: On return from adrenal venography, a patient’s blood pressure is 240/130 mm Hg, the heart rate is 144 beats per minute, and the respiration rate is 42 breaths per minute. What might be developing, and what are the appropriate interventions?

Answer: Notify the physician immediately. This patient is probably experiencing Ny R I hro GT B.C ma (pressor crisis). Venous access and adrenergic stimulation caused bU phSeocN mocytoO continuous monitoring of vital signs must be initiated. Alpha and beta-adrenergic blockade drugs should be administered immediately. After adequate blockade is accomplished, beta-adrenergic blockade drugs should be administered to reduce the heart rate. The patient should be constantly monitored until the situation is under control.

Reference page: 1024 3. Question: A patient is scheduled to undergo a thyroid scan. While obtaining a medical history of the patient, the nurse learns that the patient is receiving thyroid replacement therapy and has taken his medication today. What are the implications of this? Should the thyroid scan be cancelled?

Answer: Yes. Thyroid drugs can interfere with the results of the scan. If the patient is receiving thyroid replacement therapy, the thyroid medicine must be discontinued at least 6 weeks before the test. Any metastatic thyroid tissue will thus become particularly iodine avid.

Reference page: 870 4. Question: On a routine evaluation for lower back pain, a 54-year-old woman is found to have hypocalcemia. Her serum parathyroid hormone (PTH) intact (whole) level is 72 ng/L. What might be the cause of this patient’s high PTH? Answer: PTH is measured to assist in the evaluation of hypercalcemia or hypocalcemia.

PTH is the only hormone secreted by the parathyroid gland in response to hypocalcemia.

This patient is hypocalcemic, which could explain the high PTH. When calcium serum levels return to normal, the PTH levels should return to normal levels too.

Reference page: 395 5. Question: A patient who has a suspected adrenal tumour returns to the nursing unit after undergoing adrenal angiography. Physical assessment of the patient reveals that blood pressure is 280/140 mm Hg, pulse rate is 145 beats per minute, oral temperature is 101°F, and respiration rate is 38 breaths per minute. Is this patient having an allergic reaction to the dye?

Answer: No. One of common first signs of allergic reaction is hypotension, urticaria, and wheezing. This patient is having a serious hypertensive episode, possibly caused by a pheochromocytoma and induced by arteriography.

Reference page: 1020 6. Question: A male patient is scheduled for a 24-hour urine collection for a 17-ketosteroid (17-KS) test. During the nurse’s assessment, the patent reports that he is currently taking antibiotics for a urinary tract infection. Will this affect the test? What advice would the nurse give this patient?

Answer: This urine test is used to measure adrenocortical function by measuring 17-ketosteroids in the urine. Antibiotics can cause elevated levels of 17-KS; therefore the test should be postponed untilNthUeRcS ouIrsN eG ofTaB nt. ibC iotiM cs is completed.

Reference page: 964 7. Question: A patient is undergoing a glucose tolerance test (GTT). Thirty minutes after ingestion of the glucose, the patient vomits. What should be done?

Answer: After the patient’s vital signs are assessed, a blood glucose specimen should be obtained to ensure that the patient is not dangerously hyperglycemic or hypoglycemic.

The GTT should then be cancelled because its results are based on the ingestion and digestion of the entire glucose load. Incomplete absorption of the glucose load will invalidate the test.

Reference page: 279 8. Question: A patient is admitted to the hospital for evaluation of signs and symptoms suggestive of Cushing’s syndrome. The physician has requested that the nurse begin collecting a 24-hour urine specimen for a 17-hydroxycorticosteroid (17-OCHS) test. In the initial assessment of the patient, the nurse finds that the patient has a severe infection of the upper respiratory tract. Should the test be performed?

Answer: No. An ongoing acute infection of the upper respiratory tract acts as a physical stress on the patient. As a result, the adrenal gland may be appropriately hyperfunctioning, and elevated urine levels of 17-OCHS would be expected even in normal patients. For that reason, the nurse should notify the physician of the upper

respiratory tract infection. The physician will probably postpone the planned evaluation and treat the patient’s respiratory tract infection.

Reference page: 960

Review Questions Gastrointestinal System 1. Question: In the upper gastrointestinal (GI) series, barium swallow, and barium enema, barium is used as a contrast agent. Why is barium used to visualize the GI tract radiographically?

2. Question: A nurse is caring for an elderly patient who is taking antibiotics for pneumonia. After several days, the patient develops severe diarrhea. After a stool specimen has been collected to test for Clostridium difficile, her daughter asks how an antibiotic for pneumonia can cause diarrhea. What would be an appropriate response?

3. Question: A patient has just undergone gastrointestinal bleeding scanning in the nuclear medicine department. Her pregnant daughter is afraid to visit because her mother received an injection of a radionuclide for this test. What should the nurse advise?

4. Question: A patient’s findings are positive for the intrinsic factor antibody used to diagnose pernicious anemia. These results indicate that the patient has a lack of intrinsic factor. How would you explain to your patient that this is not related to dietary intake?

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5. Question: Before his upper GI study using barium sulphate, a patient asks if the barium will cause constipation. How should the nurse respond?

6. Question: Often the patient admitted for evaluation of the GI tract needs various diagnostic procedures performed in the shortest amount of time possible. If your patient requires an upper GI study and a barium enema study, in what order should these procedures be performed and why?

7. Question: A patient is anxious before undergoing esophageal function studies. Since admission, the patient has had an order for diazepam (Valium), as needed, for anxiety.

Should this drug be given the morning of the test?

8. Question: Is colonoscopy more accurate than sigmoidoscopy in diagnosing pathological colorectal conditions?

9. Question: A patient returns to the nursing unit after undergoing a colonoscopy and polypectomy. A regular diet is ordered. He tolerates his lunch well. Before eating supper, he begins to complain of severe abdominal pain and then vomits. What nursing interventions are appropriate in this situation?

Review Questions Answer Key Gastrointestinal System 1. Question: In the upper gastrointestinal (GI) series, barium swallow, and barium enema, barium is used as a contrast agent. Why is barium used to visualize the GI tract radiographically?

Answer: Diagnostic radiology is based entirely on contrasting densities. Barium provides a contrast medium to show any defects in normal filling and narrowing of the barium column indicating tumour, strictures, or extrinsic compression from extra-esophageal masses, or an abnormally enlarged heart and great vessels; whereas a radiograph of the abdomen would show only general shadows, fluid levels, and gas. With barium, the inside of the gut can be evaluated for pathological processes.

Reference page:1017 2. Question: A nurse is caring for an elderly patient who is taking antibiotics for pneumonia. After several days, the patient develops severe diarrhea. After a stool specimen has been collected to test for Clostridium difficile, her daughter asks how an antibiotic for pneumonia can cause diarrhea. What would be an appropriate response?

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Answer: Diarrhea may have resulted from a bowel infection caused by broad-spectrum antibiotic therapy. Antibiotics can depress the normal flora of the bowel and allow the overgrowth of other bacteria in the bowel, such as C. difficile. Infection results in watery and voluminous diarrhea.

Reference page:878 3. Question: A patient has just undergone gastrointestinal bleeding scanning in the nuclear medicine department. Her pregnant daughter is afraid to visit because her mother received an injection of a radionuclide for this test. What should the nurse advise?

Answer: The nurse should tell the patient and her daughter that only tracer doses of radioisotopes are used for this procedure. No precautions against radiation exposure are necessary.

Reference page:835 4. Question: A patient’s findings are positive for the intrinsic factor antibody used to diagnose pernicious anemia. These results indicate that the patient has a lack of intrinsic factor. How would you explain to your patient that this is not related to dietary intake?

Answer: This positive finding can be taken as confirmation of the diagnosis of pernicious anemia, and at the same time, as an indication of its cause. The patient lacks the intrinsic factor, which is needed to absorb vitamin B12 in the intestine. Therefore

vitamin B12 must be given by injection to be absorbed into the blood stream.

Reference page: 332 5. Question: Before his upper GI study using barium sulphate, a patient asks if the barium will cause constipation. How should the nurse respond?

Answer: Instruct the patient to use a cathartic (e.g., milk of magnesia) if barium sulphate was used as the contrast medium. Water absorption may cause the barium to harden and create a fecal impaction if catharsis is not carried out. Inform the patient that the colour of the stool should return to normal after the barium is completely expelled, which may take as long as a day and a half.

Reference page: 1119 6. Question: Often the patient admitted for evaluation of the GI tract needs various diagnostic procedures performed in the shortest amount of time possible. If your patient requires an upper GI study and a barium enema study, in what order should these procedures be performed and why?

Answer: Previously administered barium for an upper GI study may block visualization of the lower GI tract as it descends through the intestine. The barium enema study should precede the upper GI study because the barium ingested for other tests would obstruct visualization of the lower GI tract.

Reference page: 1118 7. Question: A patient is anxious before undergoing esophageal function studies. Since admission, the patient has had an order for diazepam (Valium), as needed, for anxiety.

Should this drug be given the morning of the test?

Answer: No. Sedation of any kind may reduce the lower esophageal sphincter pressure and cause greater acid reflux than what might have been present if the patient were not sedated.

Reference page: 718 8. Question: Is colonoscopy more accurate than sigmoidoscopy in diagnosing pathological colorectal conditions?

Answer: With fibreoptic colonoscopy, the entire colon from anus to cecum (and often a portion of terminal ileum) can be examined; however, with sigmoidoscopy it is only the rectum and sigmoid colon that can be visualized. Benign and malignant neoplasms, polyps, mucosal inflammation, ulceration, and sites of active hemorrhage can be visualized with both procedures; however, with sigmoidoscopy visualization is confined to the rectum and sigmoid colon.

Reference page: 619 9. Question: A patient returns to the nursing unit after undergoing a colonoscopy and polypectomy. A regular diet is ordered. He tolerates his lunch well. Before eating supper,

he begins to complain of severe abdominal pain and then vomits. What nursing interventions are appropriate in this situation?

Answer: Observe the patient for signs of abdominal distension, increased tenderness, or rectal bleeding. Record and monitor the vital signs. Contact the physician immediately.

Reference page:622

Pagana: Mosby’s Canadian Manual of Diagnostic and Laboratory Tests, 2nd Canadian Edition Review Questions Hematologic System 1. Question: A patient with cirrhosis was scheduled for a liver biopsy. His blood studies revealed a marked prolongation of prothrombin time. How could this be prolonged if the patient were not receiving warfarin (Coumadin) therapy?

2. Question: A patient is having blood drawn and banked for autologous transfusion after cardiac surgery. He said he has been referred to as a “universal donor” and asks the nurse to explain this term.

3. Question: A male patient who has a long history of peptic ulcer disease has a hematocrit of 24% (normal: 52%) on routine laboratory testing. His reticulocyte count is 1.5%, which is within normal limits (WNL). Given the patient’s low hematocrit, does this reticulocyte count represent adequate marrow response?

4. Question: A 72-year-old patient has suspected acute appendicitis. The white blood cell (WBC) count is 3800. Can an infectious process such as appendicitis be considered a possibility without the normally suspected leukocytosis?

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5. Question: A patient has been receiving intravenous heparin therapy (6000 U) every 4 hours for prophylaxis of deep vein thrombosis. Partial thromboplastin time (PTT) is measured at 4 PM (1 hour before the next heparin dose). The results indicate that the PTT is greater than 100 seconds. At 5 PM, bleeding develops from the patient’s gums while she is eating dinner. Shortly thereafter, she voids grossly bloody urine. What should the nurse do for this patient?

6. Question: A male construction worker is taken to the emergency department with a severe laceration of the leg. He is bleeding profusely and is in shock. After pressure is applied to the bleeding site, blood is obtained for a complete blood cell (CBC) count and crossmatching. Intravenous access is obtained with several large-bore needles, and vigorous fluid replacement is begun. The hemoglobin concentration and hematocrit results return at 14 g/dL and 52%, respectively. In view of the apparent severe hemorrhage, can these values be correct?

7. Question: A 2-year-old patient is admitted for lower gastrointestinal bleeding. The patient’s hemoglobin concentration is 78 g/L. Should this patient receive a blood transfusion?

8. Question: During blood administration, a patient suddenly suffers fever, chills, flushing of the face, shortness of breath, tachycardia, and pain along the vein into which the blood is being transfused. How should the nurse intervene, and what laboratory studies should

be performed for a suspected hemolysis blood transfusion reaction?

9. Question: A patient is being transferred to the intensive care unit following surgery after a serious motor vehicle accident. On receiving the patient, the nurse is told that the patient has required 23 units of blood. To replace clotting factors not present in banked blood, one pack of fresh-frozen plasma has been given appropriately for every 5 units of blood. In the ensuing hours, the nurse notices that the patient seems to be oozing blood from all wound and venipuncture sites. The nurse also detects cutaneous petechiae. What would be helpful in elucidating the cause of this patient’s bleeding tendency?

Pagana: Mosby’s Canadian Manual of Diagnostic and Laboratory Tests, 2nd Canadian Edition Review Questions Answer Key Hematologic System 1. Question: A patient with cirrhosis was scheduled for a liver biopsy. His blood studies revealed a marked prolongation of prothrombin time. How could this be prolonged if the patient were not receiving warfarin (Coumadin) therapy?

Answer: Many clotting factors are produced in the liver. With cirrhosis or any other hepatocellular dysfunction, synthesis of certain clotting factors does not occur, and serum levels decrease. This can result in prolongation of prothrombin time.

Reference page: 446 2. Question: A patient is having blood drawn and banked for autologous transfusion after cardiac surgery. He said he has been referred to as a “universal donor” and asks the nurse to explain this term.

Answer: Persons with group O-negative blood are considered universal donors because their red blood cells do not have antigens that would create an immunogenic reaction.

When there is insufficient time for crossmatching, group O-negative blood is often N Rbeca INuse GTthe B.C transfused in emergency situatioUns S chaOnce of a transfusion reaction is lowest with type O-negative blood.

Reference page: 140 3. Question: A male patient who has a long history of peptic ulcer disease has a hematocrit of 24% (normal: 52%) on routine laboratory testing. His reticulocyte count is 1.5%, which is within normal limits (WNL). Given the patient’s low hematocrit, does this reticulocyte count represent adequate marrow response?

Answer: No. Although the reticulocyte count is WNL according to normal values, it is actually low in view of the fact that the appropriate marrow response in this anemic patient should raise the reticulocyte count well above normal. This situation is more accurately demonstrated by a determination of the reticulocyte index, which should be 1 or greater in all patients regardless of the hematocrit level: Reticulocyte index = Reticulocyte count (%) ×

Patient’s hematocrit Normal hematocrit

In this case: Reticulocyte index = 1.5 × 24 = 0.69 52 This represents an inadequate marrow response, probably caused by iron deficiency

resulting from the chronic blood loss. The anemia is therefore caused by a combination of chronic blood loss and inadequate marrow response.

Reference page: 465 4. Question: A 72-year-old patient has suspected acute appendicitis. The white blood cell (WBC) count is 3800. Can an infectious process such as appendicitis be considered a possibility without the normally suspected leukocytosis?

Answer: Yes. Although the expected normal response to infection is elevation of the WBC count, this may not occur in geriatric and pediatric patients. Leukopenia may actually occur in response to sepsis in these patients.

Reference pages: 549 5. Question: A patient has been receiving intravenous heparin therapy (6000 U) every 4 hours for prophylaxis of deep vein thrombosis. Partial thromboplastin time (PTT) is measured at 4 PM (1 hour before the next heparin dose). The results indicate that the PTT is greater than 100 seconds. At 5 PM, bleeding develops from the patient’s gums while she is eating dinner. Shortly thereafter, she voids grossly bloody urine. What should the nurse do for this patient?

Answer: Notify the physician immediately. Further evaluate the patient for bleeding (i.e., check for blood in all excretions and assess the patient for bruises, petechiae, and low-back pain). Back pain may be a sym opBe. ritC onOeM al bleeding. Place the patient in bed NpUtoRmSoIf NreGtrT in the supine position. She may become hypovolemic and hypotensive from the blood loss. Monitor her vital signs every 15 minutes. The effects of heparin can be reversed by the parenteral administration of 1 mg of protamine sulphate for every 100 units of the heparin dose.

Reference page: 396 6. Question: A male construction worker is taken to the emergency department with a severe laceration of the leg. He is bleeding profusely and is in shock. After pressure is applied to the bleeding site, blood is obtained for a complete blood cell (CBC) count and crossmatching. Intravenous access is obtained with several large-bore needles, and vigorous fluid replacement is begun. The hemoglobin concentration and hematocrit results return at 14 g/dL and 52%, respectively. In view of the apparent severe hemorrhage, can these values be correct?

Answer: Yes, because of the time at which the blood was drawn. One of the major physiological responses to hemorrhage is complete conservation of all free body water.

This, combined with vigorous intravenous fluid therapy, tends to dilute the red blood cell (RBC) count and results in the decrease in hemoglobin that is associated with the hemorrhagic state. However, these physiological responses take time to occur. This patient’s CBC specimen was collected before these physiological responses became effective and before intravenous fluids were administered. Therefore there was no time for dilution of the RBC count and hemoglobin decrease to occur. A repeat CBC count

performed 4 to 8 hours later will probably more accurately reflect the severity of the patient’s bleeding.

Reference page: 452 7. Question: A 2-year-old patient is admitted for lower gastrointestinal bleeding. The patient’s hemoglobin concentration is 78 g/L. Should this patient receive a blood transfusion?

Answer: Decisions concerning the need for blood transfusion are usually based on the hemoglobin or the hematocrit. In an otherwise healthy person, transfusion is not considered as long as the hemoglobin level exceeds 80 g/L or the hematocrit level exceeds 0.24 volume fraction (24%). In younger people who can safely and significantly increase their cardiac output, a hemoglobin level of 60 g/L may be acceptable. In this paediatric case, there is lower GI bleeding that has not yet been controlled; therefore the physician may decide to transfuse.

Reference page: 299 8. Question: During blood administration, a patient suddenly suffers fever, chills, flushing of the face, shortness of breath, tachycardia, and pain along the vein into which the blood is being transfused. How should the nurse intervene, and what laboratory studies should be performed for a suspected hemolysis blood transfusion reaction?

Answer: Diagnostic tests for suspected hemolysis blood transfusion reaction include: - Complete blood cell coNuntR(CI BC) - Electrolytes - Blood urea nitrogen (BUN), creatinine measurements - Direct Coombs test (recipient blood, before and after transfusion) - ABO blood typing on donor and recipient blood - RH typing on donor and recipient blood - Blood crossmatch - Prothrombin time - Partial thromboplastin time (PTT) - Fibrin split products - Haptoglobin - Bilirubin - Blood cultures on donor and recipient blood - Urine for free hemoglobin-dipstick testing Reference page: 189 9. Question: A patient is being transferred to the intensive care unit following surgery after a serious motor vehicle accident. On receiving the patient, the nurse is told that the patient has required 23 units of blood. To replace clotting factors not present in banked blood, one pack of fresh-frozen plasma has been given appropriately for every 5 units of blood. In the ensuing hours, the nurse notices that the patient seems to be oozing blood from all wound and venipuncture sites. The nurse also detects cutaneous petechiae. What would be helpful in elucidating the cause of this patient’s bleeding tendency?

Answer: A common problem with multiple transfusions is dilution of the patient’s platelets. Banked blood contains few functioning platelets, and no platelets are contained in fresh-frozen plasma. A low platelet count, a normal prothrombin time, and partial thromboplastin time would document the cause of this patient’s bleeding tendency. The patient needs platelet transfusions to correct the bleeding.

Reference page: 416

Review Questions Hepatobiliary and Pancreatic System 1. Question: A patient was scheduled for a liver biopsy, but the physician cancelled the test because no coagulation studies had been performed. Why was it cancelled?

2. Question: A patient has returned from undergoing laparoscopy to obtain a biopsy sample of an abdominal mass. She asks the nurse why she is having shoulder discomfort. What should the nurse say?

3. Question: A patient in the emergency department has suspected hepatic encephalopathy.

To confirm this problem, the nurse draws blood for ammonia levels. Later, the nurse receives a call from the laboratory requesting another blood sample because of hemolysis. Why is it necessary to obtain another blood test? How can hemolysis be prevented?

4. Question: A patient is scheduled to undergo an upper gastrointestinal (GI) series and ultrasound examination of the gallbladder. Which should be performed first and why?

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5. Question: A patient is 2 monthU s prS egnaNnt aTnd is bO eing evaluated for pancreatitis. An ultrasound examination of her gallbladder and pancreas has been ordered. The patient is concerned that the test may harm her unborn child. What is the appropriate response?

6. Question: A patient was admitted in severe pain with a diagnosis of acute pancreatitis.

Should he be scheduled for endoscopic retrograde cholangiopancreatography (ERCP)?

7. Question: A patient with jaundice is scheduled for ERCP. He has been complaining of vague right upper quadrant abdominal pain. He tells the nurse that he needs a shot for pain before he undergoes ERCP. (Morphine has been ordered for him every 4 hours as needed.) What is the appropriate intervention?

8. Question: Before sending a patient with jaundice for percutaneous transhepatic cholangiography (PTHC), the nurse receives his prothrombin (PT) test results. The PT is 50% of the normal value. What should the nurse do?

9. Question: On returning from undergoing PTHC, a patient becomes hypotensive. What are the appropriate nursing interventions?

10. Question: A patient has an increase in urine amylase level and a normal serum amylase level. Could this patient have pancreatitis?

Review Questions Answer Key Hepatobiliary and Pancreatic System 1. Question: A patient was scheduled for a liver biopsy, but the physician cancelled the test because no coagulation studies had been performed. Why was it cancelled?

Answer: Many patients with liver disorders have coagulation problems that make them prone to hemorrhage. If hemostasis is impaired, liver biopsy is contraindicated in order to avoid excessive bleeding from the liver puncture. Therefore coagulation studies should be done before this test.

Reference page: 767 2. Question: A patient has returned from undergoing laparoscopy to obtain a biopsy sample of an abdominal mass. She asks the nurse why she is having shoulder discomfort. What should the nurse say?

Answer: During the procedure, carbon dioxide is inserted into the peritoneal cavity to separate the abdominal wall from the intra-abdominal viscera. This enhances visualization of pelvic and abdominal structures. After the procedure, patients may have N t fro RSmIpNneu G Tmoperi B.C Otoneum. This usually lasts only 24 shoulder or subcostal discomforU hours.

Reference page: 648 3. Question: A patient in the emergency department has suspected hepatic encephalopathy.

To confirm this problem the nurse draws blood for ammonia levels. Later, the nurse receives a call from the laboratory requesting another blood sample because of hemolysis. Why is it necessary to obtain another blood test? How can hemolysis be prevented?

Answer: Hemolysis may result from vigorous shaking of a blood specimen. This may invalidate test results. Transferring blood from a syringe to a collection tube can also result in massive hemolysis; therefore the Vacutainer technique is preferred. Also, handle the blood tube gently to prevent hemolysis.

Reference page: 22 4. Question: A patient is scheduled to undergo an upper gastrointestinal (GI) series and ultrasound examination of the gallbladder. Which should be performed first and why?

Answer: Because ultrasound waves cannot penetrate the radiopaque contrast medium used in an upper GI series, the ultrasonography should be performed first. The upper GI series is performed next.

Reference pages: 1118

5. Question: A patient is 2 months pregnant and is being evaluated for pancreatitis. An ultrasound examination of her gallbladder and pancreas has been ordered. The patient is concerned that the test may harm her unborn child. What is the appropriate response?

Answer: The nurse should reassure the patient that ultrasonography has been proved to be harmless to pregnant women and unborn children. Explain that ultrasonography is based on sound wave transmission and that the mother and child are not exposed to radiation.

Reference page: 891 6. Question: A patient was admitted in severe pain with a diagnosis of acute pancreatitis.

Should he be scheduled for endoscopic retrograde cholangiopancreatography (ERCP)?

Answer: No. On the contrary, ERCP is rarely performed on patients with acute pancreatitis because the cause of the inflammation is usually obvious (gallstones, alcohol, or penetrating peptic ulcer). However, when the cause of pancreatitis is not obvious, tumour must be ruled out. ERCP is the most reliable method to rule out pancreaticobiliary obstruction or tumour.

Reference page: 632 7. Question: A patient with jaundice is scheduled for ERCP. He has been complaining of vague right upper quadrant abdominal pain. He tells the nurse that he needs a shot for pain before he undergoes ERCNPU .R (MSoI rpN hG inT eB ha. sC beeM n ordered for him every 4 hours as needed.) What is the appropriate intervention?

Answer: Explain that morphine sulphate causes severe spasm of the sphincter of Oddi and the endoscopist cannot, therefore, catheterize the sphincter and perform the ERCP. Inform the patient that he will receive meperidine before the test and that this will alleviate his pain.

Reference page: 633 8. Question: Before sending a patient with jaundice for percutaneous transhepatic cholangiography (PTHC), the nurse receives his prothrombin (PT) test results. The PT is 50% of the normal value. What should the nurse do?

Answer: Notify the physician. He or she will probably cancel the study because inadvertent puncture of a large blood vessel in a patient with a coagulation disorder could be disastrous. The physician will probably recommend that vitamin K be administered for 2 to 3 days. Then the PT test should be repeated. If the PT test results are normal, the PTHC can be performed.

Reference page: 446 9. Question: On returning from undergoing PTHC, a patient becomes hypotensive. What are the appropriate nursing interventions?

Answer: a. Notify the physician. b. Increase the intravenous flow rate and place the patient in the Trendelenburg position. c. Assess the patient for signs of gram-negative septic shock (fever, chills, warm and flushed skin, disorientation). d. Assess the patient for signs of hemorrhagic shock secondary to inadvertent puncture of a large blood vessel (coldness, clamminess, pallor, air hunger, tachycardia). e. Draw blood for a complete blood cell count and a hemoglobin/hematocrit count. If the white blood cell count is elevated, sepsis may be present. If the hemoglobin/hematocrit count is decreased, hemorrhage may be occurring. f. If the patient is in septic shock, the physician will order appropriate antibiotics. g. If the patient is in hemorrhagic shock, blood and volume replacement should be performed. Surgery may be necessary for repair of the ruptured blood vessel.

Reference page: 1099 10. Question: A patient has an increase in urine amylase level and a normal serum amylase level. Could this patient have pancreatitis?

Answer: Yes. The early transient rise in the serum level amylase may have been missed.

The urine level stays elevated for a longer period.

Reference page: 941

Review Questions Immune System 1. Question: A patient presents with acute swelling and tenderness of the knee joint. How might an erythrocyte sedimentation rate (ESR) be helpful in this situation?

2. Question: A patient is seropositive for human immunodeficiency virus (HIV) and free of any signs or symptoms of acquired immune deficiency syndrome (AIDS). How does monitoring the HIV Viral Load contribute to the care of this patient?

3. Question: A student tells the school nurse that she has had significant fatigue, intermittent sore throat, and anorexia for 2 months. “Do I have mono?” she asks. What would be the most appropriate test to assist in this diagnosis?

4. Question: The physician has requested a rheumatoid factor test for a young adult female patient. She is terribly frightened that the physician suspects rheumatoid arthritis and that she will soon be incapacitated by joint pain. What are the appropriate nursing interventions?

N R I G B.C M

5. Question: A patient has undergU oneSantN imitT ochondO rial antibody and anti–smooth muscle antibody testing. Several hours later, the nurse notices an enlarged hematoma around the venipuncture site. What might be the cause of that hematoma, and what is the appropriate nursing intervention?

Review Questions Answer Key Immune System 1. Question: A patient presents with acute swelling and tenderness of the knee joint. How might an erythrocyte sedimentation rate (ESR) be helpful in this situation?

Answer: The ESR would not be helpful in this situation for several reasons. The ESR is often normal despite the presence of acute disease. Furthermore, the ESR cannot enable the clinician to differentiate the possible causes of this patient’s joint swelling. Septic, autoimmune, or degenerative arthritis could, in time, cause elevation of the ESR. Reference page: 237 2. Question: A patient is seropositive for human immunodeficiency virus (HIV) and free of any signs or symptoms of acquired immune deficiency syndrome (AIDS). How does monitoring the HIV viral load contribute to the care of this patient?

Answer: Quantitation of HIV viral load in the blood is used to detect HIV virus RNA in the blood of patients who are suspected of being infected with HIV. It is also used to follow the progression of acquired immune deficiency syndrome (AIDS). This NtorRS Ieco GT B.CingMthe initiation and monitoring of information is used as an indicaU for rN mmendO antiretroviral treatment (Table 2-32).

Reference page: 314 3. Question: A student tells the school nurse that she has had significant fatigue, intermittent sore throat, and anorexia for 2 months. “Do I have mono?” she asks. What would be the most appropriate test to assist in this diagnosis?

Answer: The mononucleosis test is performed to aid in the diagnosis of infectious mononucleosis, a disease caused by the Epstein-Barr virus (EBV). Usually, young adults are affected by mononucleosis. The clinical presentation is fever, pharyngitis, lymphadenopathy, and splenomegaly. Approximately 2 weeks after the onset of the disease, many patients are found to have immunoglobulin M (IgM) heterophil antibodies in their serum that react against warm red blood cells (RBCs). When these antibodies are present in serial dilutions of greater than 1:56, infectious mononucleosis is probably present. However, false-positive results can occur in patients who have other diseases that cause elevation of heterophil antibodies; for example, lymphoma, systemic lupus erythematosus, Burkitt lymphoma, leukemia, and some gastrointestinal cancers.

Reference page: 375 4. Question: The physician has requested a rheumatoid factor test for a young adult female patient. She is terribly frightened that the physician suspects rheumatoid arthritis and that she will soon be incapacitated by joint pain. What are the appropriate nursing

interventions?

Answer: The nurse should remind the patient that many diseases are associated with a positive rheumatoid factor finding. Some of these diseases are self-limiting viral infections. The rheumatoid factor test is merely a part of an immunologic workup to document a pattern associated with the disease that may explain her complaints. Also, the nurse should assist her in verbalizing her fears and frustrations concerning this workup.

Reference page: 467 5. Question: A patient has undergone antimitochondrial antibody and anti–smooth muscle antibody testing. Several hours later, the nurse notices an enlarged hematoma around the venipuncture site. What might be the cause of that hematoma, and what is the appropriate nursing intervention?

Answer: Antimitochondrial antibody and anti–smooth muscle antibody tests are performed to diagnose and distinguish forms of liver disease. These liver diseases are often associated with inadequate levels of coagulation factors. The patient may have bleeding disorder associated with Vitamin K deficiency. Ensure that the hematoma has not caused compression of the arterial supply to the hand. Notify the physician to document and determine the cause of the coagulopathy more accurately.

Reference pages: 94

Review Questions Miscellaneous Testing 1. Question: Your patient is admitted to the hospital for routine surgery. On routine admission testing, her potassium level was found to be 7 mmol/L (normal: 3.5 to 5.0 mmol/L). Should the surgery be cancelled?

2. Question: Your patient has a suspected urinary tract infection. The urine culture report indicates that three bacterial species are present. Should antibiotic therapy be initiated on the basis of the culture results?

3. Question: Your patient has been admitted for eye surgery and is found to have a positive Venereal Disease Research Laboratory (VDRL) result on routine testing. Should this patient be given antibiotic therapy?

4. Question: Your 28-year-old patient was admitted for incision and drainage of an infected pilonidal cyst. Should the routine evaluation include chest radiography and electrocardiography (ECG)?

Review Questions Answer Key Miscellaneous Testing 1. Question: Your patient is admitted to the hospital for routine surgery. On routine admission testing, her potassium level was found to be 7 mmol/L (normal: 3.5 to 5.0 mmol/L). Should the surgery be cancelled?

Answer: The elevated potassium level may be the result of red blood cell hemolysis caused by poor venipuncture technique in obtaining the specimen. Therefore, the electrolytes test should be repeated with the use of good technique.

Reference page: 422 2. Question: Your patient has a suspected urinary tract infection. The urine culture report indicates that three bacterial species are present. Should antibiotic therapy be initiated on the basis of the culture results?

Answer: It is unusual to have three bacterial species present. The sample could have been contaminated with stool, vaginal secretions, hands, or clothing resulting in false-positive results. The urine culture should be repeated.

N R I G B.C M Reference page: 1008 3. Question: Your patient has been admitted for eye surgery and is found to have a positive Venereal Disease Research Laboratory (VDRL) result on routine testing. Should this patient be given antibiotic therapy?

Answer: VDRL, by virtue of their testing for a nonspecific antibody, have high false-positive (or cross-reactive) rates. If the VDRL or RPR test result is positive, the diagnosis must be confirmed by the more specific Treponema test, such as the fluorescent treponemal antibody absorption test (FTA-ABS). If the FTA test result is positive, appropriate antibiotic therapy should be given. If the FTA test result is negative, the patient does not have syphilis, and therapy is not indicated.

Reference page: 487 4. Question: Your 28-year-old patient was admitted for incision and drainage of an infected pilonidal cyst. Should the routine evaluation include chest radiography and electrocardiography (ECG)?

Answer: Chest radiography should be included because serious pulmonary disease, which increases the risk of complications from anaesthesia, can occur at any age. The chance that ECG will demonstrate unsuspected cardiac disease is minimal. Therefore, in this age group, routine performance of ECG would not be worthwhile for clinical purposes or from a cost-benefit standpoint.

Reference page: 1053

Review Questions Nervous System 1. Question: A patient appears to be brain dead. What role does electroencephalography (EEG) play in establishing brain death before organs can be obtained for transplantation?

2. Question: A patient is scheduled to undergo magnetic resonance imaging (MRI) and is complaining of severe backache. What is the appropriate nursing intervention?

3. Question: A patient is scheduled for computed tomography (CT), and the nurse learns that he has an allergy to iodine dye. Should the nurse cancel the study?

4. Question: A patient returns to the department after undergoing cerebral angiography. He suddenly has right-sided upper and lower extremity weakness and expressive dysphasia.

What might be the cause of this patient’s problem?

5. Question: A 29-year-old patient is admitted with sudden onset of paralysis of the right hand. While talking with the patient, the nurse discovers that the patient has severe guilt feelings relating to abuse of her infant son and strongly suspects that the paralysis is a conversion reaction. Would either electroneurography or electromyelography (EMG) be indicated?

6. Question: A 50-year-old patient is admitted to the emergency department and found to be febrile and comatose. The physician prepares for a lumbar puncture. What should be evaluated before lumbar puncture is performed?

7. Question: A 22-year-old army private is being evaluated for meningitis. Several hours after lumbar puncture is performed, he complains of severe headache when standing erect. What is the probable cause of this headache, and what are the appropriate nursing interventions?

8. Question: A 48-year-old patient is admitted with the diagnosis of a possible herniated lumbar disc. Myelography is ordered. During routine physical examination, occult blood was found in the patient’s stools, and the physician has ordered a barium enema study. In what sequence should these tests be performed?

Review Questions Answer Key Nervous System 1. Question: A patient appears to be brain dead. What role does electroencephalography (EEG) play in establishing brain death before organs can be obtained for transplantation?

Answer: EEG is no longer recommended as an ancillary test for determining brain death.

Reference page: 578 2. Question: A patient is scheduled to undergo magnetic resonance imaging (MRI) and is complaining of severe backache. What is the appropriate nursing intervention?

Answer: The patient must remain motionless for long intervals during MRI because movement can distort the images. Therefore the nurse should obtain a physician’s order to administer an analgesic to the patient and reassess.

Reference page: 1151 3. Question: A patient is scheduled for computed tomography (CT), and the nurse learns that he has an allergy to iodine dye. Should the nurse cancel the study?

Answer: CT is contraindicateN dU inRpS atI ieN ntG sT wB ith.aChO isM tory of adverse reactions of allergic reactions to iodinated dye. However, a CT can be performed without the dye. Although the intravenous injection of iodine enhances the quality and sensitivity of CT, it is not necessary. An adequate study can usually be obtained without the dye. Discuss this allergy with the health care team to determine if the test should be cancelled or go ahead without the ionized dye.

Reference page: 1021 4. Question: A patient returns to the department after undergoing cerebral angiography. He suddenly has right-sided upper and lower extremity weakness and expressive dysphasia.

What might be the cause of this patient’s problem?

Answer: One of the complications of cerebral angiography is arterial embolism or stroke resulting from dislodgement of arteriosclerotic plaque. The nurse should assess the patient and report findings to the physician immediately.

Reference page: 1031 5. Question: A 29-year-old patient is admitted with sudden onset of paralysis of the right hand. While talking with the patient, the nurse discovers that the patient has severe guilt feelings relating to abuse of her infant son and strongly suspects that the paralysis is a conversion reaction. Would either electroneurography or electromyelography (EMG) be indicated?

Answer: EMG is used in the evaluation of patients with diffuse or localized muscle weakness. In combination with electroneurography, EMG can identify primary muscle diseases and differentiate them from primary neurological pathological conditions.

Reference page: 579 6. Question: A 50-year-old patient is admitted to the emergency department and found to be febrile and comatose. The physician prepares for a lumbar puncture. What should be evaluated before lumbar puncture is performed?

Answer: Before lumbar puncture is performed on any patient, the presence of increased intracranial pressure (ICP) must be ruled out. In patients with increased ICP, the quick reduction of pressure in the spinal column by release through the lumbar puncture may induce herniation of the brain. This can cause compression of the brain stem, which may result in deterioration of neurologic status and in death. In adults especially, most clinicians obtain a computed tomographic scan of the head before performing lumbar puncture, so as to identify intracranial abnormalities and thus avoid the risk of brain herniation.

Reference page: 681 7. Question: A 22-year-old army private is being evaluated for meningitis. Several hours after lumbar puncture is performed, he complains of severe headache when standing erect. What is the probable cause of this headache, and what are the appropriate nursing interventions?

Answer: The most probable cN ausR e ofIthisGtypBe. oC f heM adache is a persistent leak of the U S N T O cerebrospinal fluid through the puncture site in the dura mater. Appropriate nursing interventions include keeping the patient on bed rest, administering fluids, and administering analgesics as ordered. This patient should not have been out of bed for several hours after this procedure. Explain the reasons for bed rest to the patient. If the headache persists, he will require injection of a small amount of his own blood into the epidural space to plug the leak.

Reference page: 682 8. Question: A 48-year-old patient is admitted with the diagnosis of a possible herniated lumbar disc. Myelography is ordered. During routine physical examination, occult blood was found in the patient’s stools, and the physician has ordered a barium enema study. In what sequence should these tests be performed?

Answer: Although magnetic resonance imaging (MRI) is the preferred study to diagnose a herniated disc, myelography can be used if MRI is not available. Myelography should precede the barium enema study. If the barium enema study were performed first, the barium would obscure visualization of the radiographic dye used in myelography.

Reference page: 1033

Pagana: Mosby’s Canadian Manual of Diagnostic and Laboratory Tests, 2nd Canadian Edition Review Questions Pulmonary System 1. Question: One hour after a patient undergoes thoracentesis, the patient’s breath sounds are markedly diminished. The nurse also notes dyspnea, tachypnea, anxiety, and restlessness. Why does the physician order chest radiography?

2. Question: A patient has just returned from the radiology department, where he underwent pulmonary angiography to detect a pulmonary embolism. His left femoral vein was used for the catheter insertion site. He has begun to complain of severe left calf pain. What assessments should receive priority?

3. Question: A clinic is screening factory workers for tuberculosis by the tuberculin test.

Why should patients with a history of tuberculosis be excluded from this screening?

4. Question: A patient with pneumonia is scheduled for portable chest radiography, to be performed on the nursing unit. What precautions should the staff observe to prevent radiation exposure?

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5. Question: A 42-year-old patienU t deS veloNps T a clinicaOl picture compatible with pneumonia, but pulmonary embolism is suspected. How could a lung scan help to differentiate the diagnosis?

6. Question: The physician writes an order to monitor via pulse oximetry and maintain normal oxygen levels in a patient who has experienced smoke inhalation. Recent ABGs show normal oxygen. Does this mean the patient has normal oxygen saturation?

7. Question: Interpret the following arterial blood gas (ABG) results in a patient admitted to a unit with uncontrolled diabetes mellitus: pH = 7.25; partial pressure of carbon dioxide (PCO2) = 36 mm Hg; HCO3- = 19 mmol/L; partial pressure of oxygen (PO2) = 84 mm Hg. 8. Question: One hour later, before therapy is initiated, the arterial blood gas findings of the patient described in question 7 are as follows: pH = 7.32; PCO2 = 28; and HCO3- = 19.

Interpret these results.

9. Question: Interpret the arterial blood gas results in this patient seen in the emergency department with pneumonia: pH = 7.28; PCO2 = 60 mm Hg; and HCO3- = 32 mmol/L. 10. Question: A patient who is being evaluated for lung surgery is scheduled for pulmonary function testing (PFT). Shortly before leaving for these tests, the patient complains of severe back pain. The patient has an order for meperidine, 50 mg intramuscularly, for

pain. Should the drug be administered before PFT?

Pagana: Mosby’s Canadian Manual of Diagnostic and Laboratory Tests, 2nd Canadian Edition Review Questions Answer Key Pulmonary System 1. Question: One hour after a patient undergoes thoracentesis, the patient’s breath sounds are markedly diminished. The nurse also notes dyspnea, tachypnea, anxiety, and restlessness. Why does the physician order chest radiography?

Answer: The patient may have developed a pneumothorax caused by puncture of the lung or entry of air into the pleural space through the aspirating needle. This would be observable on a chest radiograph.

Reference page: 779 2. Question: A patient has just returned from the radiology department, where he underwent pulmonary angiography to detect a pulmonary embolism. His left femoral vein was used for the catheter insertion site. He has begun to complain of severe left calf pain. What assessments should receive priority?

Answer: His catheter insertion site should be evaluated for inflammation, hemorrhage, hematoma, and the presence of the femoral pulse. Peripheral pulses should be evaluated, NUratu RSreIoNfGthTeB.C Oity. He may have diminished pulses along with the colour and tempe extrem as a result of a blood clot. An embolectomy is probably needed.

Reference page: 1102 3. Question: A clinic is screening factory workers for tuberculosis by the tuberculin test.

Why should patients with a history of tuberculosis be excluded from this screening?

Answer: PPD testing should not be performed in patients with active tuberculosis, or patients who have received bacille Calmette-Guérin vaccine, because local skin reaction may cause complete skin slough, which would necessitate surgery.

Reference page: 1170 4. Question: A patient with pneumonia is scheduled for portable chest radiography, to be performed on the nursing unit. What precautions should the staff observe to prevent radiation exposure?

Answer: The nursing staff should, if necessary, assist the radiologic technician in the placement of the radiographic film cassette behind the patient. Then the nursing staff, visitors, and other patients should leave the room before the radiographic images are taken. If constant bedside care is needed, the nurse should wear a lead apron for protection from exposure.

Reference page: 1019

5. Question: A 42-year-old patient develops a clinical picture compatible with pneumonia, but pulmonary embolism is suspected. How could a lung scan help to differentiate the diagnosis?

Answer: When vascular obstruction (embolism) is present, the ventilation scans demonstrate normal wash-in and normal wash-out of radioactivity from the embolized lung area. If parenchymal disease (e.g., pneumonia) is responsible for the perfusion abnormality, however, wash-in or wash-out is abnormal. Therefore the “mismatch” of perfusion and ventilation on a lung scan is characteristic of embolic disorders, whereas the “match” is indicative of parenchymal disease.

Reference page: 842 6. Question: The physician writes an order to monitor via pulse oximetry and maintain normal oxygen levels in a patient who has experienced smoke inhalation. Recent ABGs show normal oxygen. Does this mean the patient has normal oxygen saturation?

Answer: In cases of carbon monoxide poisoning when carboxyhemoglobin is high, oximetry can inaccurately indicate high oxygen saturation; therefore the patient may not have a normal level.

Reference page: 124 7. Question: Interpret the following arterial blood gas (ABG) results in a patient admitted to a unit with uncontrolled diabetes mellitus: pH = 7.25; partial pressure of carbon dioxide (PCO2) = 36 mm Hg; N HCUO =I1N9GmTm L;OpM artial pressure of oxygen (PO2) = 84 R3S Bo.l/C mm Hg. Answer: The patient’s ABG findings demonstrate metabolic acidosis: The pH is acidotic, the PCO2 level is within the normal range, and the HCO3- is decreased, all of which are compatible with acidosis.

Reference page: 123 8. Question: One hour later, before therapy is initiated, the arterial blood gas findings of the patient described in question 7 are as follows: pH = 7.32; PCO2 = 28; and HCO3- = 19.

Interpret these results.

Answer: The results indicate persistent metabolic acidosis with partial respiratory compensation. The PCO2 level is decreased because the lungs are blowing off CO2 in an attempt to compensate for the acid-base derangement.

Reference page: 123 9. Question: Interpret the arterial blood gas results in this patient seen in the emergency department with pneumonia: pH = 7.28; PCO2 = 60 mm Hg; and HCO3- = 32 mmol/L. Answer: The results indicate respiratory acidosis with partial metabolic compensation.

Respiratory acidosis is documented because the increased CO2 level is compatible with the acidotic pH. The kidneys are retaining HCO3- in an attempt to compensate for the

acidotic pH. Reference page: 123 10. Question: A patient who is being evaluated for lung surgery is scheduled for pulmonary function testing (PFT). Shortly before leaving for these tests, the patient complains of severe back pain. The patient has an order for meperidine, 50 mg intramuscularly, for pain. Should the drug be administered before PFT? Answer: Yes. Pain can interfere with the patient’s ability to cooperate with deep inspiration and expiration. If the patient cannot cooperate the studies should be cancelled and rescheduled for another time.

Reference page: 1161

Pagana: Mosby’s Canadian Manual of Diagnostic and Laboratory Tests, 2nd Canadian Edition Review Questions Reproductive System 1. Question: A 51-year-old patient thinks she is experiencing menopausal symptoms but is not sure. What tests might she need?

2. Question: A 12-year-old girl is taken to the emergency department by her mother, who alleges that her daughter was raped by her husband (the daughter’s stepfather). For which tests should the nurse prepare the child? What are the important forensic, physical, and emotional nursing interventions?

3. Question: A 59-year-old woman returns to the same-day surgery unit after undergoing a hysteroscopy and endometrial biopsy. She complains of lower abdominal pain. After analgesics are provided, she is discharged. Three days later, she returns to the emergency room with persistent and worsening pelvic pain and an elevated temperature. What are the possible complications from her diagnostic surgery that could cause these symptoms, and for what test should the nurse prepare the patient at this point?

4. Question: A patient tells the nurse that she and her husband have been unsuccessful in N Rangr INyGwTithB.C M conceiving a child. Her husbandUis S her O because she has not become pregnant.

How should the nurse support her emotionally, and what testing should the couple be prepared to undergo?

5. Question: A patient has not had a Papanicolaou (Pap) smear in 5 years and asks the nurse how often she should have this test done. What should the nurse recommend?

6. Question: A neighbour calls and asks for a nurse’s advice. She has just been told that her Pap smear contains cells that “do not appear to be too good.” What should the nurse tell her?

7. Question: A patient has been trying unsuccessfully to become pregnant for 6 months.

She says she would like to have a laparoscopy to elucidate the cause of her infertility.

How might she best be advised?

8. Question: While a nurse is working during the night shift a patient, who is 36 weeks pregnant, calls and states that she had a contraction stress test (CST) that morning. She is now having vaginal bleeding and thinks her “water may have broken.” How should you advise this patient?

9. Question: A pregnant patient has been instructed to collect a 24-hour urine specimen for estriol determination to evaluate fetal viability. Because she was at a party during the evening, she voided once without collecting the urine. Should the specimen be sent for

the analysis?

Pagana: Mosby’s Canadian Manual of Diagnostic and Laboratory Tests, 2nd Canadian Edition Review Questions Answer Key Reproductive System 1. Question: A 51-year-old patient thinks she is experiencing menopausal symptoms but is not sure. What tests might she need?

Answer: Many tests are available for indicating the menopausal state. Urine testing for pregnanediol or estriol may be performed. Serum progesterone or estradiol testing more easily indicates the menopausal state. Decreased levels would be expected in the menopausal woman. Elevated levels of follicular-stimulating or luteinizing hormone indicate menopause. When these findings are combined with the symptoms of menstrual irregularity and hot flashes, menopause can be determined easily.

Reference page: 240 2. Question: A 12-year-old girl is taken to the emergency department by her mother, who alleges that her daughter was raped by her husband (the daughter’s stepfather). For which tests should the nurse prepare the child? What are the important forensic, physical, and emotional nursing interventions?

N R I G B.C M

Answer: The nurse should initiU ate tS he SNexuTal AssaOult Nurse Examiner program, now available in both Canada and the United States, which provide round-the-clock, first-response care to victims of rape in a variety of health care settings, including hospitals and clinics. These programs also have highly trained nurses who specialize in forensic specimen collection and provide patients with comprehensive post rape care and counselling. Sexual Assault Nurse Examiner programs are effective in promoting the psychologic recovery of survivors, ensuring accurate and complete collection of forensic evidence, and improving the prosecution of sexual assault cases. A “sexual assault evidence collection kit” (SAECK) is now most commonly used to obtain all the needed specimens. The directions must be followed carefully to ensure that any and all evidence is obtained and is useful toward identification and conviction of any perpetrator.

Reference page: 698 3. Question: A 59-year-old woman returns to the same-day surgery unit after undergoing a hysteroscopy and endometrial biopsy. She complains of lower abdominal pain. After analgesics are provided, she is discharged. Three days later, she returns to the emergency department with persistent and worsening pelvic pain and an elevated temperature. What are the possible complications from her diagnostic surgery that could cause these symptoms, and for what test should the nurse prepare the patient at this point?

Answer: An uncommon but possible complication from a hysteroscopy is perforation of the uterus. This could lead to a pelvic abscess, best identified by ultrasonography or computed tomography (CT) of the pelvis. Another possibility is that the patient has

cystitis that was induced during the catheterization required for hysteroscopy. A urinalysis would be helpful in determining this diagnosis.

Reference page: 642 4. Question: A patient tells the nurse that she and her husband have been unsuccessful in conceiving a child. Her husband is angry with her because she has not become pregnant.

How should the nurse support her emotionally, and what testing should the couple be prepared to undergo?

Answer: Her husband should provide a sperm specimen that will be tested for sperm quantity and motility. Besides a thorough examination, the patient can expect blood testing to indicate ovulation. Follicle-stimulating hormone, luteinizing hormone, estrogen, and progesterone metabolite levels are measured. If ovulation is believed to occur, hysteroscopy and hysterosalpingography may be performed. The patient and her husband may be tested for antisperm antibodies.

Reference page: 361, 240, 429, 106 5. Question: A patient has not had a Papanicolaou (Pap) smear in 5 years and asks the nurse how often she should have this test done. What should the nurse recommend?

Answer: The Canadian Task Force on the Periodic Health Examination’s general guidelines for screening include the following: (1) Cervical cancer screening should begin at 18 years of age if the woman has not been sexually active; (2) regardless of the patient’s age, screening shoulN d beRiniI oB nc. eC the M patient is sexually active; (3) after U Stiate NGd T the initial screening test, women should then undergo the test every 3 years after two normal results; and (4) screening can cease at the age of 70 years.

Reference page: 776 6. Question: A neighbour calls and asks for a nurse’s advice. She has just been told that her Pap smear contains cells that “do not appear to be too good.” What should the nurse tell her?

Answer: The nurse should explain to the neighbour that many possible causes exist for the type of cells reported as being “not too good.” These include inflammation and benign and malignant tumors. The nurse should tell her that her physician will probably recommend colposcopy or cervical cone biopsy. The nurse should briefly and optimistically describe both procedures and provide emotional support for the neighbour during this anxious time.

Reference page: 778 7. Question: A patient has been trying unsuccessfully to become pregnant for 6 months.

She says she would like to have a laparoscopy to elucidate the cause of her infertility.

How might she best be advised?

Answer: The patient should be helped to understand that to be considered for an infertility evaluation, she should have been trying to conceive for at least 1 year.

Furthermore, she should be told that laparoscopy is not the first step of the evaluation.

She also should be reminded that because nearly 40% of all cases of infertility are caused by a male factor, her male partner should undergo concomitant evaluation. The patient should be advised to have coitus around the time of expected ovulation for another 6 months. If she does not become pregnant, she and her male partner should then return for an infertility workup.

Reference page: 648 8. Question: While a nurse is working during the night shift a patient, who is 36 weeks pregnant, calls and states that she had a contraction stress test (CST) that morning. She is now having vaginal bleeding and thinks her “water may have broken.” How should you advise this patient?

Answer: Labour may have been unexpectedly induced by the CST. Her condition certainly warrants a physical evaluation. The nurse should recommend that she call her physician immediately to arrange for such an examination.

Reference page: 596 9. Question: A pregnant patient has been instructed to collect a 24-hour urine specimen for estriol determination to evaluate fetal viability. Because she was at a party during the evening, she voided once without collecting the urine. Should the specimen be sent for the analysis?

Answer: No. The collection mNuU stRbS eI coN mGple te. . ACnOiM ncomplete specimen may artificially TB lower the estriol value. Because a low estriol level is indicative of fetal distress, the consequences of an incomplete specimen analysis are grave. Therefore the patient should be instructed to repeat the 24-hour urine collection.

Reference page: 243, 244

Review Questions Skeletal System 1. Question: A couple takes their crying 3-year-old daughter to the emergency department because she fell off a seesaw and landed on her shoulder. Because of the child’s complaints of pain in the clavicular area, a fractured clavicle is the suspected diagnosis.

The child is extremely frightened by the thought of a radiographic examination, and her mother insists on accompanying her during the procedure. What is the appropriate intervention in this situation?

2. Question: A 17-year-old male patient is scheduled for knee arthroscopy in the morning.

When the nurse enters the room to shave the knee 6 inches above and below the joint, the knee is red and swollen. Should the arthroscopy be cancelled?

3. Question: A 62-year-old female patient underwent arthrocentesis of her right knee and an injection of steroids 2 days ago. She now complains of pain in the right knee, which she describes as worse than the initial symptoms. What is the appropriate nursing intervention?

N R I G B.C M

4. Question: A 5-year-old patient U fellSdurN ing T play theOrapy and injured his right arm. The nurse notifies the physician, who requests a radiographic examination of both arms. Why should both arms be included in the radiographic examination?

Review Questions Answer Key Skeletal System 1. Question: A couple takes their crying 3-year-old daughter to the emergency department because she fell off a seesaw and landed on her shoulder. Because of the child’s complaints of pain in the clavicular area, a fractured clavicle is the suspected diagnosis.

The child is extremely frightened by the thought of a radiographic examination, and her mother insists on accompanying her during the procedure. What is the appropriate intervention in this situation?

Answer: All X-ray procedures carry the risk of exposure to radiation. Exposure to ionizing radiation from a single test does not pose a substantial risk; however, a number of tests can result in cumulative exposure that could present a substantial risk. The mother can accompany the child but must be shielded from unnecessary exposure with lead aprons and gloves. The nurse should ask the mother if there is a possibility she may be pregnant and, if so, another person should accompany the child. During or within 10 to 12 days after normal menses, women can safely undergo diagnostic X-ray studies.

Otherwise, no women of childbearing age should be exposed.

Reference page: 1045 2. Question: A 17-year-old male patient is scheduled for knee arthroscopy in the morning.

When the nurse enters the room to shave the knee 6 inches above and below the joint, the knee is red and swollen. Should the arthroscopy be cancelled?

Answer: The nurse should notify the physician. The procedure may be cancelled because infection may be present in the knee, which is a contraindication to arthroscopy due to of the risk of sepsis.

Reference page: 611 3. Question: A 62-year-old female patient underwent arthrocentesis of her right knee and an injection of steroids 2 days ago. She now complains of pain in the right knee, which she describes as worse than the initial symptoms. What is the appropriate nursing intervention?

Answer: Severe pain 48 hours after arthrocentesis is unusual. With the injection of steroids, however, a temporary chemical arthritis frequently occurs. The administration of steroids is also associated with pain for as long as 2 days after the injection.

The patient should be reassured of this possibility, and the physician should be contacted to prescribe an appropriate pain medication.

Reference page: 670 4. Question: A 5-year-old patient fell during play therapy and injured his right arm. The

nurse notifies the physician, who requests a radiographic examination of both arms. Why should both arms be included in the radiographic examination?

Answer: Fracture lines of the long bones in children are often difficult to distinguish from normal growth lines on radiographs. If the suspect line is seen in the radiographs of both arms, the physician can be confident that a fracture did not occur. However, if the suspect line is unilateral, the bone is probably fractured.

Reference page: 1045

Pagana: Mosby’s Canadian Manual of Diagnostic and Laboratory Tests, 2nd Canadian Edition Review Questions Urinary System 1. Question: A patient returns from her physician’s appointment and discusses her scheduled workup for hypertension with the nurse. She asks why she needs to avoid ingesting licorice before several tests. What would the nurse tell her?

2. Question: A nurse’s father had his annual physical examination, which included a digital rectal examination. His doctor wanted a blood test for prostate-specific antigen (PSA) but told the patient that he had to wait and have the test on another day. Does the nurse have any explanation for this inconvenience?

3. Question: A patient has undergone a cystoscopy for evaluation of hematuria. On return to the unit, the nurse encourages him to drink fluids. He reports a burning sensation with urination, however, and does not want to drink fluids. How should the nurse handle this problem?

4. Question: A healthy, 28-year-old construction worker is admitted to the emergency department for evaluation after a fall. His laboratory results indicate an increased blood NUnalRSfailIN B.COility? urea nitrogen (BUN) level. Is re ureGT a possib 5. Question: Computed tomography of the kidney is ordered for a trauma patient whose vital signs are stable. After the injection of the iodinated dye, the patient becomes flushed and hypotensive and develops severe bronchospasms. What should be done?

6. Question: A patient is scheduled for computed tomography (CT) of the kidney and ureters. His creatinine level is 198 mcmol/L, and his blood urea nitrogen (BUN) level is 15.2 mmol/L. Will the kidneys be visualized on CT? 7. Question: A patient has undergone a renal biopsy. Shortly afterward, he develops severe back and leg pain on the side from which the biopsy specimen was obtained. He develops nausea and begins vomiting. His blood pressure drops from 140/100 mm Hg to 100/68 mm Hg. What should be done for this patient?

8. Question: A patient is scheduled for computed tomography (CT) of the kidneys.

Immediately prior to the procedure the patient informs the nurse that he forgot to tell her about his allergy to shellfish. Is this a concern?

9. Question: A patient returns to the nursing unit after transcystoscopic removal of a biopsy specimen from the bladder. A Foley catheter is in place. Thirty minutes after his return, the nurse notes bright red clots in the Foley catheter bag. He begins to complain of lower abdominal midline pain and is mildly hypotensive. What are the appropriate interventions

for this patient?

10 Question: A patient is scheduled to receive a nephrotoxic drug. She has no suspected renal disease or injury, but her creatinine clearance rate is only 1.2 mL/sec. What should be done?

11. Question: A 28-year-old woman who is menstruating goes to the emergency department complaining of a sudden onset of colicky, left-sided back pain that radiates to the groin.

A ureteral calculus (stone) is suspected. The urinalysis shows RBCs. How should this be interpreted?

12. Question: A patient develops bleeding from a peptic ulcer. His routine laboratory studies indicate a blood urea nitrogen (BUN) level of 21.2 mmol/L and a creatinine level of 96 mcmol/L. Does this patient have renal disease?

Pagana: Mosby’s Canadian Manual of Diagnostic and Laboratory Tests, 2nd Canadian Edition Review Questions Answer Key Urinary System 1. Question: A patient returns from her physician’s appointment and discusses her scheduled workup for hypertension with the nurse. She asks why she needs to avoid ingesting licorice before several tests. What would the nurse tell her?

Answer: Licorice has an aldosterone-like effect, which increases sodium reabsorption in the kidney and raises blood pressure. Licorice ingestion would affect renin and aldosterone studies.

Reference page: 463 2. Question: A nurse’s father had his annual physical examination, which included a digital rectal examination. His doctor wanted a blood test for prostate-specific antigen (PSA) but told the patient that he had to wait and have the test on another day. Does the nurse have any explanation for this inconvenience?

Answer: Yes. The rectal examination causes prostate manipulation, which would elevate PSA levels. At least 24 hours must pass before this blood can be drawn for this test.

Reference page: 436

N R I G B.C M U S N T O

3. Question: A patient has undergone a cystoscopy for evaluation of hematuria. On return to the unit, the nurse encourages him to drink fluids. He reports a burning sensation with urination, however, and does not want to drink fluids. How should the nurse handle this problem?

Answer: The first few times the patient voids after cystoscopy, a burning sensation may be felt in the urethra. This may be intense. Encourage men to urinate while sitting to avoid a vagal reaction related to severe dysuria. Instruct the patient to increase fluid intake because dilution of the urine will decrease the burning sensation with urination.

Reference page: 629 4. Question: A healthy, 28-year-old construction worker is admitted to the emergency department for evaluation after a fall. His laboratory results indicate an increased blood urea nitrogen (BUN) level. Is renal failure a possibility?

Answer: Probably not. In view of his age and type of work, dehydration must be considered. Levels of BUN are increased with dehydration and decreased with overhydration.

Reference page: 535 5. Question: Computed tomography of the kidney is ordered for a trauma patient whose

vital signs are stable. After the injection of the iodinated dye, the patient becomes flushed and hypotensive and develops severe bronchospasms. What should be done?

Answer: Notify the physician immediately. Adverse reactions or allergic reactions to iodinated dye can include flushing, itching, urticaria, and even severe life-threatening anaphylaxis (evidenced by respiratory distress, decreased blood pressure, or shock). In the unusual event of anaphylaxis, diphenhydramine (Benadryl), steroids, and epinephrine are included in resuscitative efforts. Oxygen and endotracheal equipment should be on hand for immediate use. Adverse reactions may also be delayed for up to 1 week after the procedure. Delayed reactions are usually skin reactions, including maculopapular rash, erythema, urticaria, and angioedema.

Reference page:1021 6. Question: A patient is scheduled for computed tomography (CT) of the kidney and ureters. His creatinine level is 198 mcmol/L, and his blood urea nitrogen (BUN) level is 15.2 mmol/L. Will the kidneys be visualized on CT? Answer: Yes. Even with the decreased renal function, the kidneys will be visualized.

More time, however, is required for visualization.

Reference page: 1059 7. Question: A patient has undergone a renal biopsy. Shortly afterward, he develops severe back and leg pain on the side from which the biopsy specimen was obtained. He develops nausea and begins vomiting. H s bRloSoI dN prGesTsB ur. eC dropMs from 140/100 mm Hg to 100/68 NiU mm Hg. What should be done for this patient?

Answer: Notify the physician immediately. Complications from renal biopsy include hemorrhage from the highly vascular renal tissue and inadvertent puncture of the liver, lung, bowel, aorta, or inferior vena cava. Note that the patient’s blood may need to be typed and crossmatched in case of severe hemorrhage that necessitates transfusions.

Assess the patient for signs and symptoms of hemorrhage (e.g., decrease in blood pressure, increase in pulse rate, pallor, backache, flank pain, shoulder pain, light-headedness). Evaluate the patient’s abdomen for signs of bowel or liver penetration (e.g., abdominal pain and tenderness, abdominal muscle guarding and rigidity, decreased bowel sounds). Inspect all urine specimens for gross hematuria. In most cases, the patient’s urine contains blood initially, but this generally does not continue after the first 24 hours. Urine samples may be placed in consecutive chronologic order to facilitate comparison for evaluation of hematuria. To assess for active bleeding, obtain blood to determine hemoglobin and hematocrit level after the biopsy. One lavender-top tube of blood is needed.

Reference page: 783 8. Question: A patient is scheduled for computed tomography (CT) of the kidneys.

Immediately prior to the procedure, the patient informs the nurse that he forgot to tell her about his allergy to shellfish. Is this a concern?

Answer: Yes. Allergy to shellfish is one of the contraindications to the CT because the iodinated dye may trigger an allergic response in these patients. The physician should be notified immediately and the procedure postponed until the patient is further assessed.

Reference page: 1021 9. Question: A patient returns to the nursing unit after transcystoscopic removal of a biopsy specimen from the bladder. A Foley catheter is in place. Thirty minutes after his return, the nurse notes bright red clots in the Foley catheter bag. He begins to complain of lower abdominal midline pain and is mildly hypotensive. What are the appropriate interventions for this patient?

Answer: Bright red clots are not normal. Assess catheter patency as per institution policies and notify physician. There may be bleeding from the biopsy site. Monitor the patient for complaints of back pain, and bladder spasms.

Reference page: 629 10. Question: A patient is scheduled to receive a nephrotoxic drug. She has no suspected renal disease or injury, but her creatinine clearance rate is only 1.2 mL/sec. What should be done?

Answer: The nurse should notify the physician and not administer the drug. The creatinine clearance reflects the ability of the glomeruli to act as a filter and it is decreased by diseases such as glomerulonephritis, acute tubular necrosis, and most other primary renal diseases. AdminNisteRringIa nGephBro.toCxicMdrug to a patient with renal disease U S N T could result in significant damage to the kidneys. A complete workup is necessary to elucidate the patient’s renal problem.

Reference page: 208 11. Question: A 28-year-old woman who is menstruating goes to the emergency department complaining of a sudden onset of colicky, left-sided back pain that radiates to the groin.

A ureteral calculus (stone) is suspected. The urinalysis shows RBCs. How should this be interpreted?

Answer: A common cause of RBCs in the urine of women is contamination because of menses. In a voided specimen from a menstruating patient, the presence of RBCs may not be associated with the presence of a stone. The only way to obtain an adequate specimen is by urethral catheterization.

Reference pages: 996 12. Question: A patient develops bleeding from a peptic ulcer. His routine laboratory studies indicate a blood urea nitrogen (BUN) level of 21.2 mmol/L and a creatinine level of 96 mcmol/L. Does this patient have renal disease?

Answer: No. The creatinine level is normal. The BUN level is elevated because there is an increased gastrointestinal absorption of protein (blood), which is metabolized to urea.

In patients with normal renal function who develop gastrointestinal bleeding, BUN levels

are elevated. The BUN level returns to normal as soon as the gastrointestinal hemorrhage ceases.

Reference page: 534, 205