Chapter 34 Diagnostic Testing Answers for Review Questions 1. The nurse who recognizes and analyzes clues among laboratory results should immediately report which of the following to the primary care provider (PCP)? (Select all that apply.) a. Hemoglobin: 15.6 g/dL b. Hematocrit: 31% c. Red blood cells: 5.3 × 106/μL d. White blood cells: 2,000 cells/mm3 e. Platelets 230,000 cells /mm3 Answer: b, d Normal hematocrit levels range from 42% to 52% for males and 37% to 47% for females. White blood cells should be between 5,000 and 10,000 cells/mm3 for adults. The results for the hemoglobin, red blood cells, and platelets are within normal ranges. LO: 34.2 Bloom’s: Understanding NCLEX Client Needs: Physiological Integrity: Laboratory Values 2. The patient is taking an oral anticoagulant (warfarin). Which of the following laboratory results should the nurse recognize as being the most clinically significant for this patient? a. Platelets: 400,000 cells/mm3 b. INR: 5.9 c. Activated partial thromboplastin time: 30 seconds d. Fibrinogen: 350 mg/dL Answer: b An increased international normalized ratio (INR) indicates prolonged bleeding times. The normal INR is between 0.8 and 1.1 for a patient not taking an anticoagulant. Warfarin increases prothrombin times—the INR should be between 2 and 3 or 3 and 4 depending on the patient’s risk level. An INR level of 5.9 is dangerously high and puts the client at risk for bleeding. The other levels are within normal limits. Copyright © 2023 by Elsevier, Inc. All rights reserved. LO 34.2 Bloom’s: Understanding NCLEX Client Needs: Physiological Integrity: Laboratory Values 3. Put the following steps in the correct sequence for obtaining a capillary blood glucose. a. Cleanse the site with alcohol and allow to dry. b. Ensure that hands are washed. c. Select the site and put on gloves. d. Quickly puncture the skin with the lancet. e. Cover the test strip with full blood sample. f. Wipe away the first drop of blood with gauze. Answer: b, c, a, d, f, e First, wash hands. Then, select the site and put on gloves. Cleanse the finger with alcohol and allow to dry. Puncture the site with the lancet, then obtain the blood sample. The first drop should be wiped away and the second drop of blood should be collected on the test strip. Cover the entire test strip with blood to obtain the glucose result on the meter. LO 34.8 Bloom’s: Applying NCLEX Client Needs: Physiological Integrity: Laboratory Values 4. A male patient with heart disease asks the nurse what his ideal numbers should be for cholesterol and triglycerides. Which of the following is the recommended level for lipids? a. Total cholesterol: >200 mg/dL b. LDL: >100 mg/dL c. HDL: >45 mg/dL d. Triglycerides: >160 mg/dL Answer: c Recommended levels for high-density lipoprotein (HDL) cholesterol are >45 mg/dL for males and >55 mg/dL for females. The total cholesterol level should be < 200 mg/dL, the low-density Copyright © 2023 by Elsevier, Inc. All rights reserved. lipoprotein (LDL) cholesterol level should be < 130 mg/dL, and the triglyceride levels should be <160 mg/dL for males and <135 mg/dL for females. LO: 34.2 Bloom’s: Remembering NCLEX Client Needs: Physiological Integrity: Laboratory Values 5. The nurse is preparing a patient for a barium swallow test. Which statement(s) by the patient indicate that the patient has understood the nurse's teaching? (Select all that apply.) a. “The doctor will be able to view my stomach and intestines during the test.” b. “I should increase fluids after the test.” c. “I will have to drink a contrast agent.” d. “Barium can cause constipation and I may need a mild laxative.” e. “I will be NPO for 8 hours after the test.” f. “My stools may turn black for a few days afterward.” Answer: a, b, c, d The doctor will be able to view the esophagus, stomach, duodenum, and upper portion of the jejunum during a barium swallow (upper GI series). Ulcers, hiatal hernias, and carcinomas can be visualized during the test. The patient will receive an oral contrast agent (barium sulfate), which outlines the organs on X-ray. Patients should be instructed to increase fluid intake after the test to help excrete the barium, which can cause constipation. Some patients may need a mild laxative. Patients can usually eat and drink immediately after the test. Stools may turn white for a few days as the barium is expelled. LO: 34.4 Bloom’s: Applying NCLEX Client Needs: Physiological Integrity: Diagnostic Tests 6. A patient has a 24-hour urine specimen ordered for creatinine clearance. Which education should be provided by the nurse? a. “Collect all urine from the time the collection begins until it ends.” b. “Save only a sample from each voiding.” c. “Clean the perineal area three times before beginning to urinate.” Copyright © 2023 by Elsevier, Inc. All rights reserved. d. “Discard the first urine specimen, and then collect all urine until the time period expires.” Answer: d Discarding the first void ensures that the test begins with fresh urine specimens. The patient needs to void when the test begins and discard that uring then save all urine until the end of the collection period. Because this does not require a sterile specimen, the cleansing process is not needed. LO: 34.8 Bloom’s: Understanding NCLEX Client Needs: Physiological Integrity: Laboratory Values 7. Which patient specimens should be collected by the nurse using sterile technique in a sterile container? (Select all that apply.) a. Clean-catch urine b. Stool for occult blood c. Wound drainage d. Sputum e. Urine from a Foley catheter Answer: a, c, d, e Clean-catch urine, urine from a Foley catheter, wound drainage, and sputum should be collected using sterile technique and in sterile containers. All are collected to determine presence of bacteria or infection. Thus, the inside of the specimen container is kept sterile to avoid contamination of the specimen. A stool for occult blood does not need to be sterile; a stool for culture needs to be collected in a sterile container. LO: 34.8 Bloom’s: Applying NCLEX Client Needs: Physiological Integrity: Laboratory Values 8. Which blood test would the nurse expect to be elevated in a patient with chronic renal failure? a. Creatine kinase Copyright © 2023 by Elsevier, Inc. All rights reserved. b. Triglycerides c. Creatinine d. Alkaline phosphatase Answer: c Creatinine is a by-product of skeletal muscle metabolism and is excreted by the kidneys. It is released from the muscles at a consistent rate, and blood levels give an accurate reflection of renal filtration. It would be elevated in a patient with renal failure. Creatine kinase is released during cardiac, skeletal, or brain cell damage. Triglycerides reflect dietary intake and risk of cardiovascular disease. Alkaline phosphatase provides information about liver function. LO: 34.2 Bloom’s: Analyzing NCLEX Client Needs: Physiological Integrity: Laboratory Values 9. For which patient is magnetic resonance imaging (MRI) contraindicated? a. A patient with an allergy to latex b. A patient with an infection c. A patient with an inner ear implant d. A patient with a head injury Answer: c Inner ear implants may contain metal and can be pulled out of position by the strong magnetic force generated in magnetic resonance imaging. Latex allergy, infection, and head injury are not contraindications. LO: 34.4 Bloom’s: Understanding NCLEX Client Needs: Physiological Integrity: Diagnostic Tests 10. The nurse is caring for a patient after a lumbar puncture to obtain a cerebrospinal fluid specimen. Which are appropriate postprocedure interventions? (Select all that apply.) a. Position the patient with the head of the bed up at least 90 degrees for 4 hours. b. Assess the puncture site for drainage or bleeding. Copyright © 2023 by Elsevier, Inc. All rights reserved. c. Encourage oral fluids. d. Maintain NPO until the gag reflex returns. e. Encourage ambulation immediately after the test is complete. Answer: b, c After lumbar puncture, patients should be instructed to lie flat for 4 to 8 hours. The site should be assessed for drainage and bleeding. Patients should be encouraged to increase PO fluids. Since a lumbar puncture does not involve the pharynx, the gag reflex does not apply, and patients can eat and drink after the procedure. LO: 34.8 Bloom’s: Applying NCLEX Client Needs: Physiological Integrity: Basic Care and Comfort Copyright © 2023 by Elsevier, Inc. All rights reserved.
