Specimen Collection And Diagnostic Testing

MATCHING Directions: Match the suffix оп the /eft to the correct definition оп the right and give ап ехатр/е for еас/1. (667) d с: =к: __fu_ Suffix 1. 2. з. 4. -oscopy -ogram -ography -centesis а. Delinition Procedure involving puncture of а body cavity Example \ \V\a№\')"\о8. r f h � MoJ'nroo 5ro.m ::S:bD( � С en te s 5 Ь. Procedure in which an image is produced с. Actual image or results of а test Example (1 Example d. Procedure in which bo'iJ structures are visualized Example FIGURE LABELJNG 5. Directions: Label the veins of the arms and hands оп the figure. (683) Basilic vein Cephalicvein Med.ian cubltal vein RttdtaJ ;•eia (Q\�Y\0.)(Q _\ r� � \,Ст" V� � '�� � rJ :\Ч с._,.)."( � -:J Median vein of forearm Superficial dorsal vein Dorsal venous arch l�� - m.ел,��, t,\J\'o\ <(._V\\�� C-ephalic R�dioJ- v�,п ��---.ll ��� t)\ MUL ТIPLE СНО/СЕ Oirections: Select the best answer(s) for еас/1 of thefollowing questions. Which la"';'rato':Y Ыооd test is more likely to cequ1re w-ntten iniormed consent? (64'9) 1. Comp!ete Ыооd count 12\ Human immunodefidency virus test У. PlateJet count 4. B!ood glucose testing 9. The_ patient reports seeing black, tarry stoo!. Which question 1s the nurse most likely to ask? 8. (673) "Are you straining or noticing discomfort with bowel movements?" 2. "Have you eaten а Iot of red meat in the past few- days?" "Are you ha�g any pain or discomfortin th е upper m1d-a bdomen?" 4. "Have you ever had а proЬlem with hem_ orrh01ds? 1. @) 10. The clin.ic nurse sees that the provider has or­ dered а sputum spedmen for add-fast bacillus. _ Wha� 1s the nurse most Jikely to clarify with thе roV1der? (673) p 1 · "Sha_ll I in�truct the patient to collect the �peomen m the early morning?" 2. If th patient cannot expectorate а speci7 men, 1s nasotracheal suction allow-ed ?" 3. "Is the patient allowed to smoke, drhtk, r:\ and eat after the sputurn is collected?" "Should the patient Ье placed in а negative , _. . , pressure isolation room?" V 11. The postsшgica] patient лаs chills, fever, and malaise. The provider лаs instructed tле nurse to report the Iabo�atory results as soon as they �е availaЫe. Which laboratory result is defini­ tive for confirmation of infection and effective treatment? (673) 1. White Ыооd се11 count ф Wound culture and sensitivity 3. Red Ыооd ceJl count 4. Electrolyte levels 12• According to the Ыoodborne pathogen stan­ dards of Occupational Safety -�d Health �d­ ministration, health care faa\ities are required to make а written exposure control plan. Which health care worker has sustained а ma­ jor significant exposure? (681) 1. Nursing student injures self while recap­ ping а needle used to draw up the patient' s insuLin. 2. UAP picks up Ыood-stained lirien without donning g1oves. 3. Nurse sustains а deep cut with profuse Ыeeding while trying to raise а patient's side rails. Phlebotomist sustains а deep puncture caused Ьу а needle used to collect Ыооd. €) 13. What is the best rationale for drawing at least two Ыооd cultures from two different sites? (681) Тl:ris is the standard method used to detect bacterernia. 2. If only one culture shows bacteria, techniis assumed. (:'\ cian error If both cultures show an infecting agent, V bacterernia is confirmed. 4. If both cultures show different infecting agents, skin contamination is assumed. 1. 14. The nurse is planning care for several patieдts . who will need postprocedural care. Which patient will require serial neurovascular assess�nts �n bilate:al extremities? (654) \:И Patient havmg cardiac catheterization 2. Patient having,a bone scan З. Pa�ent ha�ng electrocardiography 4. Patient havmg paracentesis 15. The nurse is interviewing � patient who needs to Ье scheduled for colonoscopy. Which patient comment would cause the nurse to contact the provider before giving instructions for the usual oral bowel preparation? (655) 1. "I take insulin for my diabetes." 2. "1 have heard the bowel prep is awful" cr.) "1 think I might have acute diverticulitis." "Му father died of colon cancer." У. 16. The patieлt had а co/onoscopy_ 2 h= ��Ье and reports that aЬdoJnlllal pain • Jd the nurse increasing. What assess�en� wi: perform jf со]ол perforaьon 15 5 Рected? Se-­ )e.!:t all lhat apply. (655) are w,·th baseliлe. \t) Take vitaJ signs and compfor tendemess 2: Geлt!y paJpate abdomen and disteлtion. . • n to check З. Perform digital rectal exam.inatJo for Ыооd. • ds. 4 Observe for tolerance of clea.r orа1 flшcolor � Observe stools for Ыeeding and лоtе '-...,1 and arnouлt. 17 Shortly after the patient retumS from having а • liver Ьiopsy, he reports chest pa.in an� trouble breathing. Не seems restless and aruaous. The RN says that he m.ight have а pneumothorax. What will the nurses do before calling the p ror!i,der? Select all that apply. (660) \!;./ Assess rate, rhythm, and depth of respirations. 2. Check pulse oximeter reading. 3. Assess Ыооd coagulation profile. Q) Listen to breath sounds. 5. Apply oxygen i1 needed. 18. Тhе postoperative patient dernonstrates some mild dizziness and mild shortness of breath wheл moving from sitЬng to standing position. Which Jaboratory vaJue would the nurse check ,,Ji{st? (692) (..J.) Red Ыооd cell count 2. White Ы(Х)d cell count 3. Blood шеа nitrogen 4. Creatinine level J 9. Prior to а paracentesis, which assessments should Ье performed? Select all that appl . y А.62) � 2. ф ф 5. Weight Height AbdorninaJ girth Baseline vital signs Peripheral pulses 20. The nurse n�eds to perform veni puncture on an old er patient whose veins are very fragile. _ Whдt 15 the Ьest strategy for the nurse to use? (661) А W Gently tap over the vein. Apply а warm compress. 3. Use а vacutainer. 4. Use а small-gauge needle. ared is usiлg а commerciallr1cprep 21. The nurse llection of ал aerob wound tube_fo:nthf:�� ture. After collecting the speq_ ecuri sp w•.th the swab' what should the nurse do? men 79 �18ce the swab into the collection_ tuЬe, • cJose it tightly, and keep the spec11nen the specia\ 2. 1a':c':'tii.e swab and mix it with color-changing reagent m the collection tube. .L 11 . 3. Place the swab into u,e со �ctюn tube "11(\ medшm. culture d add the liqui t.\ Crush the ampule at the en� of the tube \:::_i and put the tip of the swab mto the solution. 22. Following а lumbar puncture, what d�s the nurse do to prevent а postpuncture spinal headache? (660) . . А Reduces the patient's flшd mtake Fowler' s posi­ high а in patient the � Places tion 3. Informs the provider if а headache develops • • to liе' mthе supme 4. Instructs thе patient position i6 23. The patient is to have а thoracentesis per­ forrned. Тhе nurse assists the patient to which position for this test? (664) 1. Dorsal recumЬent .,)... Supine with the arms held above the head � Sitting up and leaning over а taЪle 4. Side-lying with the knees drawn up 24. The patient requests information about а scheduled magnetic resonance imaging study. What should the nurse tel1 the patient to ex­ pect? (661) 1. "You shouldn't eat or drink for 4 hours be­ fore the test." :'You will hear humming and loud thump­ mg sounds." 3. "You will have minor discomfort in the area being tested." 4. ":?u will Ье assisted to make frequent Po­ s1tion changes." @ 25. The nurse is teachin the atien t how to col­ g p lect а speci men for Ыооd lucose moni g toring. _ _ Which patient action demonstrates correct ,.,teфnique? (671) '1..) Allows the Ыооd specim en to drop onto the test strip 2. Uses the center of the finger for the ture 3. Н:olds the finger upright after punctute punc­ 4. V1gorously squeezes the fingertip after puncture 26. What is iлcluded in the instructions to the patient for collection of а rnidstream urine sample? (668) 1. Use а clean specimen cup and try not to touch the iлside of the cup. 2. Collect at least 200 ml of urine into the specirnen cup. @ Void into the toiJet, stop urinating, and then urinate into the cup. Bathe or shower the perineal area before collection. 27. The student nurse is obtajлing а urine speci­ men from а patieлt with ал e:>dsting iпdwelling catheter. When would the supervising nurse intervene? (667) 1. Performs hand hygiene and applies clean х;;/. gloves for the procedure. У5,< Clarnps the_ dramage tubing for 30 minutes r:;-\ b�fore specunen collection begins. \::.) D1s�onnects the catheter from the drainage tubmg and collects the шine in а specimen cup. 4. Unclamps the drainage tuЬe after collec­ tion and observes for urine flow. 28. The patient will Ъе catheterized for residual urine. What is the correct techruque for thj5 procedure? (667) 1. Catheterize the patient when the Ыadder is fu/1. 2. Obtain an order for an indwelliлg catheter. Catheterize the patient withjn 10 minutes of voiding. 4. Use clean technique to obtain the sample. ® 29. А patient requires venipuncture to obtain а blood sample for cliagnostic testing. Which laboratory resu]t is the greatest concern related to the -venipuncture? (680) .,,1.. High Ыооd glucose Jevel � Low platelet count 3. Elevated Ыооd urea nitrogen 4. Low sodium level 30. How does the nurse properly use а tourniquet when performing а venipuncture? (682) 1les it into а single knot С.:) Leaves it in place for no more than 1-2 min­ utes 3. Places it 6-8 inches above the selected site 4. 1ies it tight enough to occlude the distal pulse А 31. The patient is suspected of having а urinary d tract inlection (UTI). Тhе prov1der has ordere а urine specimen for cul�,re a1;ct s�IlSitivity get а testing. The patient asks, Can t 1 Ju_st the best prescription for antiЬiotics?" What ,s response? (673) .• •• 1. "Tlus is just а routiл.e test for any patl.ent suspected of having а l!Tl." 2. "Your provider feels this test _1s ,�ecessary in determining your d1agnos1s. 3. "I can contact your provider if you ,vould li.ke to ask for а prescription." Г:....... "Different bacteria can cause а UП and. . ant1b1indlcate the Ьest \::,, the test results ' ' wil1 • otic." 32. When performing а Hemoccult slide test to de­ termine the presence of occult Ыооd in а stool specimen, the nur�e would Ье correct m per­ forming which actюn? (674) (D Use two separate �asen.of the stool when oЫaining the specпn . 2. Obtain the specimen from the totlet bowl. 3. Perform the test, control before obtaining. the specimen. 4. Take the specimen iromediately to the labo­ ratory to preven� hemolysis. 33. An older patient had а broncrюscopy several hoшs ago and now seems restless and con­ fused compared to Ъaseline behavior. Which assessment is the most important? (654) ,J.;. Orientation to person, place, and time \:) Pulse oximeter reading and respiratory rate 3. Use of antian:>dety medications dшing pro­ cedure 4. Time of last food and tluid ingestion 34. An older female patient is supposed to have di­ agnostic testing that requires nothing Ъу moutr for 12 hours prior to the test and а bowel preparation. The test has been cancelled 2 days in а row; once for а large amount of retained stool and once because of equipment proЬleJru Which intervention is the priority? (652) 1. Explain the cancellations to the patient us· ing terms that she can easily understand. 2. Call the diagnostic technician to ensure (:'\ that the test gets done. \V Assess the patient for dehydration and fluid and electrolyte im.Ьalances. 4. Call the provider and ask if the test can Ъ postponed for а few days. 35. The nurse has just infoпned tl atient that he Р . the mom. ,еen shouJd collect а sputum spec� u:'11 the nurse ing. Which add.itional instrиction wt give? (673) ,vash J·ust 1. "Brush you.r teeth and use .mou th ,, prior to collect:iлg the spec,men. colle "Drink extra water the day before u -�� � tion to decrease the trucl<лess of mucsp 3. "Inhale and cough deeply апd �;1en tt tl,e cup. sler1Ie tl1e clear saliva into _ 4. "Do not eat any red meat or drink any сaffeinated beverages." 36. Тhе nшse has just received laboratp� resul ts for an unfamiliar test, so he is unsure 1f the re­ suJts are withiп normal Jimits. What should the nurse do first? (650) 1. Call the provider and read ilie results ex­ actly as they are shown. 2. Ask th.e patient if he is having any unusual symptoms or complaints. 3. Call ilie Jaboratory techrudan and ask for ал explanation of tlle results. f'4.'\ Слесk ilie facility's Jaboratory manual for \.::.,1 information about ilie test. G) 37. Тhе nurse has orders for voided m.idstream шiпе specimens for several patients. Which patient is most Jikely to require an order for а straight catheterized specimen rather than а voided midstream specimen? (668) 1. А 25-year-t:Jld fema]e who finished her menstrua] period yesterday 2. А 55-year-old female diabetic patient who is very overweight 3. А 63-year-o/d male whohas difficulty with urination due to prostate proЬ!ems (7\ � An 18-year-old male wlю bas а Glasgow сота score of 4 after а head injury 38. The nurse sees tliat several patients requir e sto?I spea_mens for diagnostic testing. Whic h pati�nt's stool specimen must Ье taken im­ me�tely to tlie laboratory afte r it has been Ataшed? (669) \..!) Patient travele � to а forei country and rep��ts abdomщal crampgn ing with di arrhea 2. Patient saw very dark Ыасk stool several • da�s ago, Ьut now stool seems normal. 3. Pati ent (smaJI cblld) is suspected of swal­ _ lo�mg а plastic marЫe з days ago. 4. Patient saw stool floatin g in toilet and there was an oily film in the water. to оЬtащ . ctioning the patient 39. The nurse 15 su en. During the 10 seconds of tu а sp� _m s���;ardiac monitor shows.brady­ sucti_orung, tient becшnes very d1apho­ car d1a n a t.h�i;:bes t explanation for this oc_ Wh atd 15 ret1c. ,. ? (67:3) · trated anxiety due to the r �� ;,:�:nt dernons · · Procedure. d hypoxiaЬy suctiorung for а 2. Nurse cause . prolonged tiJne. late d to thе proceЗ. Cardiac changes are unre dure. . ulation . о 1 vaga,\ ,,-::;-'\ Catheter caused direct stнn \:::.,/ nerve fibers. �he nurse notes purulent c!:ainage from а 40• wound and decides to оЫаm Ю; order for аeo wound culture, Prior to contacting the surg n, what other data will the nurse оЫаm? Se�ect .,,щ_l that apply. (673) 'U) Check oral temperature. ф Look at trends of white Ыооd cell count. ф Ask about subjecti,re symptoms such as chills or fatigue. Q Assess for pain at the wound site. 5. Review the previous documentation about thewou.nd. 41. А patient is newly admitted for pneumonia with possiЫe early sepsis. The nurse is review­ ing the admission orders. Which order should Ье done first? (681) 1. Intravenous antiЬiotics ф Blood cultures from two sites 3. Chest x-ray 4. Blood chemistries 42. The n�se is supervising а nursing studen t who will perform venipuncture to obtain а Ыооd sample for Ыооd chemistries. Тhе nurse will intervene if the student erfoпns which p �on? (682) (И Applies а warm cornpress to the arm on the si de of а rnastectomy _ 2. Obtams а vacutainer and different colors of collection tubes 3. Applies а tourni uet 3 'inch q es above elЬow and palpates the antecuЬital space 4• Rel_eases the tourni quet after 2 minutes of trymg to locate а vein atient had а diagnostic study w·1 h а con­ um 4 hours ago. Now 11 е 43· А �t medi _tra and itch.ing arotmd the eyes а а� swcll­ pulse, JП� mild dyspnea. What shou]d thrap,ct е nurse do ал t? (650) � Admi11ister ал as-needed (PRN) dose of diphenhydrarruлe and call the rovider Call tl:e R ap1d RE:sponse Team p and brin. _ 2_ resusatation eqшpment to the beds'd g З. Contact the heaJth care team meщb�r :,ho adJТLinlstered the contrast rnediu l 4_ App y а cool compress to reduce е swell ing апd iлstruct the patient to rest. made two atternpts to test а patieлt:'s 4-4. Тhе UAP Ь]ооd g!ucose but was unaЫe to get enot, h Ь]ооd to �dequately cover the test strip. vYr,at factors w1l1 лurse .assess that could interfere wit/1 gettmg an adequate drop of Ыооd?• s е 1 ееt tJtat apply. (665, 671) Envirf for а m1ld local anesthetic that will tempor.uily suppress tЬе gag re­ flex. 48. The'nurse needs to perform veniplmt�r': to obtain а Ыооd sample-for-Ыood �eШis_tr,es. What factors influences the nurse s cho1ce of erile needles? Select all that apply. (685) � Age of patient Condition of veiлs А Nurse's familiarity witb product '4J Syringe method versus vacuum tube meth, od , 5. Туре of Ыооd chemistry test ordered 6. Color of the collection tube 49. Nurse Ais aware that Nurse В, who is not very skiПed at venipuncture, is sticking her patients rnore than the recommended two times as stated Ьу hospital policy. What should Nurse А clo first? (686) 1. Report Nurse В to the nurse manager for violating hospital policy. 2. Watch Nurse В and offer to perform veni­ punctures after two attempts. 3. Assess Nurse B's understanding and skill in performing venipuncture. ([) Ask the charge nurse to assess Nurse B's understanding of hospital policy. 50. As the nwse is performing an electrocardio­ gram (ECG), the patient reports very mild left anterior chest pain. What should the nurse do firi;t? (656) . . , 1. Stop the procedure and oЬtain the crash cart and other emergency equipm�nt. Continue the procedure, anq. tell the pa­ tient to relax and not to wопу., 3. Stop the procedure and oЪtain an order for pain medication. 4. Continue procedure and make notation of pain on the request slip or ECG strip. ® � CR/TICAL ТНINKING ACTIVITIES а thoracentesis. . whO iS . schedu]ed to have 51. Тhе nurse js caring for а pattent . ���"--"'�....__.=..,... а. • . раь.. еnt's lung sounds and presence of cougЪ. . this Ь. Why woul HЬeparttcularly imРortaлt to assess ) before the p rocedure? (бб4 ...l..ho \. 1- "�i" C_\D� ✓1\ ол+1Ь '(, X(U'Y) \\') 0 :vn« _ Х¼ ;-� мау w {)__ \\lV"\ s ½'\-\:YI о S\йbDS ) -\istm�{fi��1:;;, �St<.rmlho ½<> CD.pe ЬeSf а==°" -C T\u Ot· ьv P . . ntbeforeandduringthe • pahe \ the care of rL(to the� related �o с. Describe the nшsmg responsi'b'lities 1 -forrY\ � �$ thoracentesis.(649, 664) . J• m I/ �е, - .п he' ·ur-c.. 1ven lh.forme C0!1.Senf. • the d. Descnbe assessments an d care th а t the nurse should perform after the thoracentesis procedure. . �iiw &$Ro/:1!. Q� <� The пшsе is 0 52. : caring for а 68-year-old woman who is schedu and ап intravenous pyelogram (IVP). The atient is alert led to have а urinalysis, Ыооd chemistries, and cooperative. She is thin and reports appetite and lluid intake. The patient demopnstra а poor ha-':1-� and s�me n:ioЫ!ity is ues rel ted t arthri tes some trouЫe with fine motor movements of the tis, � but she is a?le to independently perf � _ � tiv1ties of da1Jy livm orm most ac­ g. Identify cons1derations for this older patient with regards to the urin chemistries, and IVP. (665) alysis' Ыооd Аs о nurse 1 \ wo u d \ -et") coura3e pa:Ьent