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Saunders Diagnostic Testing Questions 1. A client is being prepared for a thoracentesis. The nurse should assist the client to which position for the procedure? Rationale: To facilitate removal of fluid from the chest, the client is positioned sitting at the edge of the bed leaning over the bedside table, with the feet supported on a stool; or lying in bed on the unaffected side with the head of the bed elevated 30 to 45 degrees. The prone and Sims' positions are inappropriate positions for this procedure. Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process: Implementation Content Area: Fundamentals of Care: Diagnostic Tests Strategy(ies): Subject Priority Concepts: Clinical Judgment, Safety ‘oy Lying in bed on the affected side a Lying in bed on the unaffected side 3: Sims' position with the head of the bed flat 4. Prone with the head turned to the side and supported by a pillow 2. The nurse is preparing to care for a client who has returned to the nursing unit following cardiac catheterization performed through the femoral vessel. The nurse checks the health care provider's (HCP's) prescription and plans to allow which client position or activity following the procedure? Rationale: After cardiac catheterization, the extremity into which the catheter was inserted is kept straight for 4 to 6 hours. The client is maintained on bed rest for 4 to 6 hours (time for bed rest may vary depending on the HCP's preference and on whether a vascular closure device was used) and the client may turn from side to side. The head is elevated no more than 30 degrees (although some HCPs prefer a lower position or the flat position) until hemostasis is. adequately achieved. Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process: Planning Content Area: Fundamentals of Care: Diagnostic Tests Strategy(ies): Subject Priority Concepts: Perfusion, Safety ‘os Bed rest in high Fowler's position a Bed rest with bathroom privileges only 3. Bed rest with head elevation at 60 degrees 4. Bed rest with head elevation no greater than 30 degrees 3. A client is about to undergo a lumbar puncture. The nurse describes to the client that which position will be used during the procedure? Rationale: A client undergoing lumbar puncture is positioned lying on the side, with the legs pulled up to the abdomen and the head bent down onto the chest. This position helps to open the spaces between the vertebrae and allows for easier needle insertion by the health care provider. The nurse remains with the client during the procedure to help the client maintain this position. The other options identify incorrect positions for this procedure. Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process: Implementation Content Area: Fundamentals of Care: Diagnostic Tests Strategy(ies): Subject Priority Concepts: Intracranial Regulation, Safety 1. Side-lying with a pillow under the hip a Prone with a pillow under the abdomen 3. Prone in slight Trendelenburg's position 4, Side-lying with the legs pulled up and the head bent down onto the chest 4. The nurse provides information to a client scheduled for a dual x-ray absorptiometry (DEXA) test. Which information should the nurse provide to the client? Select all that apply. Rationale: The most commonly used screening and diagnostic tool for measuring bone mineral density is the dual x-ray absorptiometry (DEXA) test. Itis a painless test that emits less radiation than a chest x-ray. A height is taken before the start of the test. The client stays dressed but is asked to remove any metallic objects such as belt buckles, coins, keys, or jewelry because they may interfere with testing. No special follow-up care for the test is necessary. Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process: Implementation Content Area: Fundamentals of Care: Diagnostic Tests Strategy(ies): Subject Priority Concepts: Clinical Judgment, Sensory Perception 1. It is a painless test. 2. It emits slightly more radiation than a chest x-ray does. 3. Upper body clothing will need to be removed for testing 4. Increased fluid intake is necessary following the procedure. 5. Metallic objects such as jewelry or belt buckles may interfere with the test and need to be removed. 5. The nurse working in the outpatient radiology department is giving discharge instructions to a client who has had a bone scan. Which instruction should the nurse include in the client's teaching plan? Rationale: The client should drink large amounts of water for 24 to 48 hours to excrete the radioisotope through the kidneys. No special diet or activity prescriptions or restrictions are required after a bone scan. Nausea or flushing would accompany allergic reaction to a dye, which is not used in this procedure. Client Needs: Physiological Integrity Integrated Process: Nursing Process: Planning Content Area: Fundamentals of Care: Diagnostic Tests Strategy(ies): Subject Priority Concepts: Gas Exchange, Safety 1. Intubation tray es Morphine sulfate injection 3. Portable chest x-ray machine 4. Chest tube and drainage system 8. The nurse has a prescription to obtain a 24-hour urine collection in a client with a renal disorder. Which actions should the nurse take when collecting this specimen? Select all that apply. Rationale: The nurse should first explain the procedure to the client and ask the client to void at the beginning of the collection period and to discard this urine sample. All subsequent voided urine is saved in a container. which is placed on ice or refrigerated. The client is asked to void at the finish time, and this sample is added to the collection. The container is labeled, placed on fresh ice, and sent to the laboratory immediately. Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process: Implementation Content Area: Fundamentals of Care: Diagnostic Tests Strategy(ies): Subject Priority Concepts: Clinical Judgment, Elimination 1. Explain the procedure to the client. 2. Save all subsequent voidings after the first void during the 24-hour period. 3. During the collection period, place the main container on ice or in a refrigerator. 4. Have the client void at the end time, and place this specimen in the main container. 5 Have the client void at the start time, and place this specimen in the main container. 9. How should the nurse position the client for pericardiocentesis to treat cardiac tamponade? Rationale: The client undergoing pericardiocentesis is positioned supine with the head of bed raised to a 45- to 60-degree angle. This places the heart in close proximity to the chest wall for easier insertion of the needle into the pericardial sac. Options 1, 2, and 3 are incorrect positions. Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process: Implementation Content Area: Fundamentals of Care: Diagnostic Tests Strategy(ies): Subject Priority Concepts: Clinical Judgment, Safety 1 Supine with slight Trendelenburg's position 2. Lying on the right side with a pillow under the head 3: Lying on the left side with a pillow under the chest wall 4. Supine with the head of the bed elevated at a 45- to 60-degree angle 10. A stool smear for culture needs to be obtained from a client. What steps should the nurse plan to implement when obtaining the specimen? Select all that apply. Rationale: A stool smear specimen is obtained using sterile gloves and a sterile container. {It IS very important to use a wooden applicator to put the stool in the sterile container; it is NOT necessary to obtain the first bowel movement of the day} After obtaining the specimen, the stool is sent immediately to the laboratory. Storing a stool specimen for culture in a refrigerator is contraindicated because it can retard the growth of organisms. The client needs to be positioned in a lateral recumbent position to obtain the sample. Cognitive Ability: Applying Client Needs: Safe and Effective Care Environment Integrated Process: Nursing Process: Implementation Content Area: Fundamentals of Care: Diagnostic Tests Strategy(ies): Subject iority Concepts: Elimination, Infection 1. Wearing sterile gloves 2. Using a sterile container 3: Refrigerating the specimen 4. Sending the specimen directly to the laboratory 8. Positioning the client in a dorsal recumbent position 11. The nurse is caring for a client with possible cholelithiasis who is being prepared for intravenous cholangiography and is teaching the client about the procedure. Which statement indicates that the client understands the purpose of this test? Rationale: An intravenous cholangiogram is done for diagnostic purposes. It outlines both the gallbladder and the ducts, so gallstones that have moved into the ductal system can be detected. X-rays are used to visualize the biliary duct system after intravenous injection of radiopaque dye. This test is diagnostic and does not involve irrigation, instillation of medications, or drainage of the gallbladder. Cognitive Ability: Evaluating Client Needs: Physiological Integrity Integrated Process: Nursing Process: Evaluation Content Area: Fundamentals of Care: Diagnostic Tests 2. On the right side 3: Head slightly elevated 4. Head lower than the rest of the body 14, The nurse provides discharge instructions to a client following myelography. Which instructions should the nurse provide? Select all that apply. Rationale: A myelogram uses x-rays and contrast material to view the bones and the fluid-filled space (subarachnoid space) between the bones in the spine. Following the procedure, the client needs to increase fluid intake to flush the contrast material. Since dye is injected and spinal fluid leakage is a concern, the client should avoid bending over, avoid strenuous exercise, and rest with the head elevated. Clear drainage from the dressing site indicates cerebrospinal fluid leakage, requiring health care provider notification. Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Teaching and Learning Content Area: Fundamentals of Care: Diagnostic Tests Strategy(ies): Subject Priority Concepts: Client Education, Intracranial Regulation 1. Restrict fluid intake. 2) Avoid bending over. 3. Avoid strenuous exercise. 4. Rest with the head elevated, 5. Expect some clear drainage from the dressing site. 15. A fasting blood glucose screening test is performed on a pregnant client. The results indicate that the blood glucose level is 140 mg/dL (8 mmol/L). The nurse should anticipate that which treatment measure would most likely be prescribed next for the mother? Rationale: A maternal glucose level is done to screen for gestational diabetes. A 50-g oral glucose load may be prescribed and is followed by a serum glucose determination 1 hour later. If the test is done without regard for fasting, 140 mg/dL (8 mmol/L) is the upper limit of normal. If the test is done when the woman is fasting, the upper acceptable limit is 135 mg/dL (7.7 mmol/L). Clients exceeding these limits should be further evaluated with a 3-hour glucose tolerance test. The remaining options would not be prescribed based solely on the maternal glucose level. Further follow-up would be implemented. Cognitive Ability: Analyzing Client Needs: Physiological Integrity Integrated Process: Nursing Process: Planning Content Area: Fundamentals of Care: Diagnostic Tests Strategy(ies): Comparable or Alike Options Priority Concepts: Glucose Regulation, Reproduction 1. An oral hypoglycemic agent 2: A 3-hour glucose tolerance test 3. Humulin N insulin on a daily basis 4. Asliding-scale regular insulin dose 16. The nurse is caring for a client who is going to have arthrography with a contrast medium. Which assessment by the nurse would be of highest priority? Rationale: Because of the risk of allergy to contrast dye. the nurse places highest priority on assessing whether the client has an allergy to iodine or shellfish. The nurse also reinforces information about the test, assists the client to void before the procedure, and tells the client about the need to remain still during the procedure. Cognitive Ability: Analyzing Client Needs: Safe and Effective Care Environment Integrated Process: Nursing Process: Assessment Content Area: Fundamentals of Care: Diagnostic Tests Strategy(ies): Strategic Words Priority Concepts: Clinical Judgment, Safety 1. Allergy to iodine or shellfish 2. Whether the client wishes to void before the procedure 3. Ability of the client to remain still during the procedure 4. Whether the client has any remaining questions about the procedure 17. A client suspected of having an abdominal tumor is scheduled for a computed tomography (CT) scan with dye injection. How should the nurse describe this test to the client? Rationale: CT scanning causes no pain and can take 15 to 60 minutes to perform. The dye may cause a warm, flushing sensation when injected. Fluids are encouraged following the procedure. If an iodine dye is used, the client should be asked about allergies to seafood or iodine. Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process: Implementation Content Area: Fundamentals of Care: Diagnostic Tests Strategy(ies): Subject Priority Concepts: Caregiving, Client Education 1. The test may be painful. 2. The test will take approximately 2 hours. 3. Fluids will be restricted following the test. 4, The dye injected may cause a warm, flushing sensation. Rationale: Potential complications after renal angiography include allergic reaction to the dye; renal damage from the dye; and vascular complications, which include hemorrhage, thrombosis, or embolism. The nurse detects these complications by noting signs and symptoms of allergic reaction, decreased urine output, hematoma or hemorrhage at the insertion site, or signs of decreased circulation to the affected leg. Cognitive Ability: Evaluating Client Needs: Physiological Integrity Integrated Process: Nursing Process: Evaluation Content Area: Fundamentals of Care: Diagnostic Tests Strategy(ies): Subject ‘jority Concepts: Perfusion, Safety 1. Urine output, 50 mL/hr a Blood pressure, 110/74 mm Hg 3. Pallor and coolness of the left leg 4, Absence of hematoma in the left groin x N a 2 3 3 § a 8 3 2. 5 a 8 2 Q 2 3 Z om z a 3 2. 8 3. a 2. 3 3 3 8 S & = BR 3 3 3 8 s Fa 8 a g = 3 2 o 2 | i= 3 a a 8 > 3 FA 8 Es z further instruction? Client Needs: Physiological Integrity Integrated Process: Teaching and Learning Content Area: Fundamentals of Care: Diagnostic Tests Strategy(ies): Subject, Strategic Words, Negative Event Query Priority Concepts: Clinical Judgment, Client Education 1. "Telemonitoring ignores artifact." es "These systems are not fail-proof.” 3. "Monitoring helps to diagnose dysrhythmias, ischemia, or infarction.” 4. “Electrodes have to be replaced when the conductive gel has dried out.” 23. The nurse is preparing to obtain a sputum specimen from a client. Which nursing action will facilitate obtaining the specimen? Rationale: To obtain a sputum specimen, the client should rinse the mouth to reduce contamination, breathe deeply. and then cough into a sputum specimen container. The client should be encouraged to cough and not spit so as to obtain sputum. Sputum can be thinned by fluids or by a respiratory treatment such as inhalation of nebulized saline or water. The optimal time to obtain a specimen is on arising in the morning. Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process: Implementation Content Area: Fundamentals of Care: Diagnostic Tests Strategy(ies): Subject Priority Concepts: Clinical Judgment, Safety 1. Limiting fluids 2. Having the client take 3 to 4 deep breaths 3. Asking the client to spit into the collection container 4. Asking the client to obtain the specimen after eating 24. A female client is scheduled to have a chest radiograph. Which question is most important for the nurse to ask when assessing this client? Rationale: The most important item for the nurse to ask about is the client's pregnancy status, because pregnant women should not be exposed to radiation. Clients also are asked to remove any chains or metal objects that could interfere with obtaining an adequate film. A chest radiograph most often is obtained at full inspiration, which gives optimal lung expansion. If a lateral view of the chest is prescribed, the client is asked to raise the arms above the head. Most films. are done in a posterior-anterior view. Cognitive Ability: Applying Client Needs: Safe and Effective Care Environment Integrated Process: Nursing Process: Assessment Content Area: Fundamentals of Care: Diagnostic Tests Client Needs: Physiological Integrity Integrated Process: Nursing Process: Assessment Content Area: Fundamentals of Care: Diagnostic Tests Strategy(ies): Subject Priority Concepts: Cellular Regulation, Clinical Judgment 1. Insignificant and unrelated to pheochromocytoma es Lower than normal, ruling out pheochromocytoma 3. Higher than normal, indicating pheochromocytoma 4. Normal results for a client with pheochromocytoma 27. With a finger sensor the nurse is measuring a client's oxygen saturation with a pulse oximeter machine and obtains a reading of 78% while the client is on oxygen via nasal cannula at 2 L/min. The client is showing no signs of restlessness or dyspnea. What is the first nursing action? Rationale: Note that the low reading does not match the client's signs and symptoms. The first action by the nurse is to ensure that the test was done properly and the reading is accurate. The nurse should not increase the oxygen without a health care provider's prescription. The results of the test should be verified before any other actions are taken, and this can be done quickly. Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process: Implementation Content Area: Fundamentals of Care: Diagnostic Tests Strategy(ies): Steps of the Nursing Process, Strategic Words, Data in the Question Priority Concepts: Gas Exchange, Perfusion 1. Increase the client's oxygen to 4 L/min. 2. Check the finger sensor's position and repeat the test. 3. Notify the client's health care provider about the low reading. 4. Check the client's chart to find out what the previous readings have been. 28. A client is scheduled to have a needle liver biopsy. During the procedure, the nurse should instruct the client to take which action? Rationale: For the health care provider to have optimal access to the liver during a liver biopsy, the client should be instructed to lie in a supine position with the right arm over the head. {After liver biopsy, the pt should be kept on the affected (RIGHT) side}. options 1 and 2 are not positions that would provide access to the liver. During a liver biopsy, the client needs to remain still and expire fully, not breathe deeply, while the needle is inserted. Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process: Implementation Content Area: Fundamentals of Care: Diagnostic Tests Strategy(ies): Subject Priority Concepts: Client Education, Safety 3. 4 29. The clinic nurse reads the results of a tuberculin skin test performed on a 5-year-old child who is at low risk for contracting tuberculosis. The results indicate an area of induration measuring 10 mm. How would the nurse interpret Lie on the right side. Assume a lithotomy position. Breathe deeply as the needle is inserted. Lie supine with the right arm over the head. these results? Rationale: Induration measuring 15 mm or greater is considered a positive result in a child 4 years of age or older who has no associated risk factors. {Please note that induration of 10 mm or greater is considered positive for TB with the exception of immunocompromised pt such as HIV/AIDS, then induration of 5 mm or greater is considered positive for TB} options 1, 3, and 4 are incorrect interpretations. Cognitive Ability: Analyzing Client Needs: Physiological Integrity Integrated Process: Nursing Process: Analysis Content Area: Fundamentals of Care: Diagnostic Tests Strategy(ies): Comparable or Alike Options, Subject Priority Concepts: Clinical Judgment, Infection 30. A client returns to the nursing unit after undergoing an esophagogastroduodenoscopy (EGD). Which is the Positive Negative Inconclusive Requiring arepeat test appropriate nursing intervention? Rationale: In preparation for the passage of the endoscope, an anesthetic is sprayed to inactivate the gag reflex and thus facilitate passage of the tube. It may take 1 to 2 hours for the anesthetic spray to wear off and for the gag reflex to return. The client should remain on bed rest in a semi Fowler's position until fully alert. A sore throat is expected because of the endoscopic tube. Cognitive Ability: Applying Client Needs: Safe and Effective Care Environment 1 Liquid 2. Fat-free 3: Low-protein 4. High-carbohydrate 33. The nurse has a prescription to collect a 24-hour urine specimen from a client. The nurse is demonstrating correct procedure when which technique is performed? Rationale: Because the 24-hour urine test is a timed quantitative determination, the test must be started with an empty bladder: therefore, the first urine is discarded. Fifteen minutes before the end of the collection time, the client should be asked to void, and this specimen is added to the collection. The urine sample should be placed in the appropriate container and may be refrigerated or placed on ice to prevent changes in the urine. Because this is a quantitative determination of constituents in the urine, no urine should be removed from the container. Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process: Implementation Content Area: Fundamentals of Care: Diagnostic Tests Strategy(ies): Subject Priority Concepts: Clinical Judgment, Elimination dy Ask the client to void, save the specimen, and note the start time. 2. Place the specimen in various containers as necessary for the test. 3. Ask the client to save a sample voided at the end of the collection time. > Remove urine from the collection container for other prescribed specimens. @ 35. The nurse is explaining to a client what electroencephalography (EEG) involves. What response by the client indicates that further teaching is needed? Rationale: An EEG is noninvasive, not minimally invasive. All of the other options are correct. Cogni : Evaluating Client Needs: Physiological Integrity Integrated Process: Teaching and Learning Content Area: Fundamentals of Care: Diagnostic Tests Strategy(ies): Subject, Strategic Words, Negative Event Query Priority Concepts: Clinical Judgment, Safety 1. “This test is minimally invasive." 2. "There is no risk of electric shock." 3 “It can help diagnose and treat my seizures." 4 “Electrodes are placed on specific areas of my scalp." 39. A client has just returned from the cardiac catheterization laboratory. The left-sided femoral vessel was used as the access site. How should the nurse position the client? Rationale: Following cardiac catheterization, the extremity used for catheter insertion is kept straight for 4 to 6 hours. If the femoral artery was used, strict bed restis necessary for 6 to 12 hours. The client may turn from side to side. The head of the bed is not elevated more than 15 degrees (unless otherwise prescribed) to prevent kinking of the blood vessel at the groin and possible arterial occlusion. Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process: Implementation Content Area: Fundamentals of Care: Diagnostic Tests Strategy(ies): Comparable or Alike Options, Subject jority Concepts: Clotting, Perfusion 1. Knee chest, with the foot of the bed elevated 2 Supine, with the head of the bed elevated 45 to 90 degrees 3. Semi Fowler's, with the knees placed on top of 1 pillow 4. Supine, with the head of the bed elevated about 15 degrees AO. The nurse is assisting the health care provider with a bedside liver biopsy. When the procedure is complete, the nurse assists the client into which position? Rationale: Following a liver biopsy, the client is assisted to assume a right side-lying position with a small pillow or folded towel under the puncture site for at least 3 hours. This helps to immobilize the area and provides pressure to minimize bleeding in this vascular organ. The other options are incorrect. Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process: Implementation Content Area: Fundamentals of Care: Diagnostic Tests Strategy(ies): Subject Priority Concepts: Clotting, Safety 1. Left side-lying, with the right arm elevated above the head > Right side-lying, with the left arm elevated above the head 3. Left side-lying, with a small pillow or towel under the puncture site 4, Right side-lying, with a small pillow or towel under the puncture site 41. The client with right-sided pleural effusion by chest x-ray is being prepared for a thoracentesis. The nurse should assist the client to which position for the procedure? Rationale: To facilitate removal of fluid from the pleural space, two positions may be used. The client may be positioned sitting on the edge of the bed, leaning over the bedside table, with the feet supported on a stool. The other position is lying in bed on the unaffected side, with the head of the bed elevated 45 degrees (Fowler's position). The other options are incorrect because they do not facilitate drainage of fluid to an area easily removed with thoracentesis. Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process: Implementation Content Area: Fundamentals of Care: Diagnostic Tests Strategy(ies): Subject Priority Concepts: Clinical Judgment, Gas Exchange 1. Sims' position, with the head of the bed flat 2. Prone, with the head turned to the side supported by a pillow 3: Left side-lying position, with the head of the bed elevated 45 degrees 4, Right side-lying position, with the head of the bed elevated 45 degrees 42. A client is about to undergo a lumbar puncture (LP). Which position should the nurse tell the client will be used during the procedure? Rationale: The client undergoing LP is positioned lying on the side, with the legs pulled up to the abdomen and the head bent down onto the chest. This position helps to open the spaces between the vertebrae and allows for easier needle insertion by the health care provider. Each of the other options is incorrect. Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process: Implementation Content Area: Fundamentals of Care: Diagnostic Tests Strategy(ies): Subject ‘jority Concepts: Clinical Judgment, Safety 1. Prone, with a pillow under the abdomen 2. Prone, in a slight Trendelenburg's position 3: Side-lying position, with a pillow under the lower back, hip, and knees 4. Side-lying position, with legs pulled up and head bent down onto the chest 
