Question 1

A nurse is scheduling a laboratory appointment for a patient who needs to have blood drawn for adrenocorticotropic hormone (ACTH)levels.The best time for this test is:
A)0600-0800
B)2100-2300
C)Anytime that is convenient for the patient
D)Within 12 hours after strenuous exercise

Accepted Answer

The best time for measuring ACTH levels is in the morning between 6:00 am and 8:00 am when the levels are naturally highest.

Question 2

A 90-year-old patient has a carotid duplex ultrasound that shows stenosis of 40% to 60% and a moderate amount of plaque.Which nursing action is most appropriate for this patient?
A)Advise the patient that surgery is indicated as soon as possible.
B)Avoid use of aspirin or products containing aspirin.
C)Instruct the patient to immediately report any changes in speech, balance, or vision.
D)Recommend that the patient restrict activity until medication decreases the stenosis.

Accepted Answer

Instructing the patient to immediately report any changes in speech, balance, or vision is most appropriate, as this can indicate the development of a stroke. As the patient's stenosis is not severe, surgery is not immediately necessary. Avoiding aspirin or restricting activity is not necessary based on this level of stenosis.

Question 3

A geriatric patient asks a nurse about the significance of a bone mineral densitometry (DEXA)T-score measurement of -0.75.What response by the nurse is most accurate?
A)"A negative score on DEXA indicates that you are at a much higher risk of sustaining fractures because your bone density is lower than average."
B)"DEXA compares the amount of bone you have with that a young adult of the same gender with peak bone mass.A T-score above -1 is considered normal."
C)"This kind of scan is not very reliable for geriatric patients.You need to know your Z-score to interpret the significance of this test."
D)"Your T-score of -0.75 means you have osteoporosis, and you will need to take medication to improve your bone mass."

Accepted Answer

This response is the most accurate because it explains the meaning of the T-score in relation to the average bone density of a young adult of the same gender. It also clarifies that a score above -1 is considered normal, which helps the patient understand the significance of their score. The other options either overstate the patient's risk or misunderstand the interpretation of the DEXA score.

Question 4

Prior to beginning a urine collection for catecholamine, a nurse should instruct a patient to:
A)Increase fluid intake during the 12 hours immediately preceding the test.
B)Limit consumption of bananas, beer, aged cheese, chocolate, and coffee.
C)Maintain an active pattern of exercise for at least 24 hours.
D)Restrict dietary intake of sodium for 3 days.

Accepted Answer

Limiting consumption of foods and beverages that contain high levels of catecholamines (such as bananas, beer, aged cheese, chocolate, and coffee) can help ensure accurate test results. Increasing fluid intake or exercise, or restricting sodium intake, are not typically necessary instructions for this test.

Question 5

Which instruction should a nurse provide to a patient in preparation for a gastric acid stimulation test?
A)"An IV dose of pentagastrin will be administered at the start of the procedure."
B)"Antacids should be taken at bedtime and in the morning prior to the procedure."
C)"No food or fluid for at least 12 hours, but chewing gum or mouthwash can be used the morning of the procedure."
D)"The procedure requires insertion of a nasogastric tube to collect stomach contents."

Accepted Answer

The answer of Which instruction should a nurse provide to...

Question 6

A patient's arterial blood gases are pH 7.29, HCO₃-24 mEq/L, PO₂ 74, PCO₂ 52 mm Hg.A nurse assessing this patient should observe for signs and symptoms of: A)Metabolic acidosis. B)Metabolic alkalosis. C)Respiratory acidosis. D)Respiratory alkalosis.

Accepted Answer

The patient's arterial blood gases indicate a pH below the normal range (7.35-7.45), suggesting acidosis. The elevated PCO2 (above the normal range of 35-45 mm Hg) points towards respiratory acidosis, as it indicates CO2 retention, a common cause of acidosis through respiratory mechanisms.

Question 7

A nurse is assisting with a radionuclide bone scan of a patient.The radionuclide has just been administered and initial images have been taken to assess blood flow to the bones.How long of a delay should occur at this point to allow the radionuclide to be taken up by the bones before the complete skeleton is imaged?
A)10 to 15 minutes
B)30 minutes to 1 hour
C)2 to 3 hours
D)4 to 5 hours

Accepted Answer

Radionuclide bone scans typically require a delay of 2 to 3 hours after the radionuclide is administered to allow sufficient time for the radionuclide to be taken up by the bones before imaging the complete skeleton. This delay ensures that the images will accurately reflect the distribution of the radionuclide in the bone tissue, which can indicate areas of abnormal bone metabolism.

Question 8

When collecting any specimen for laboratory analysis, what should be a nurse's first priority?
A)Communicating with the patient about the laboratory test being performed
B)Identifying the patient with the health-care facility's two specific, unique identifiers, such as full name and date of birth
C)Informing the patient of the purpose of the specimen collection
D)Labeling the specimen with the patient's name, room number, or address

Accepted Answer

The nurse's first priority should be ensuring accurate identification of the patient to prevent errors in specimen collection and analysis. This includes using the healthcare facility's two specific, unique identifiers to confirm the patient's identity before collecting the specimen.

Question 9

One hour after starting a unit of packed red blood cells, a nurse observes that a patient receiving the transfusion is reporting flank pain and has a temperature of 101.8$\degree$F (38.8$\degree$C).The nurse's first action should be to:
A)Assess the patient for signs of rash, hives, or angioedema.
B)Confirm that the name on the label on the blood transfusion matches the patient's armband.
C)Medicate the patient with acetaminophen that is ordered prn for pain or fever.
D)Stop the transfusion and maintain IV access with normal saline.

Accepted Answer

The patient is exhibiting signs of a transfusion reaction, which can be life-threatening. The first action should be to stop the transfusion immediately to prevent further harm. Maintaining IV access with normal saline will ensure the patient remains hydrated while the healthcare team assesses the situation further. Once the patient is stable, further investigation can be pursued to determine the cause of the reaction.

Question 10

A nurse is attempting to insert a needle to obtain a blood specimen from a 4-year-old, but the child, who is being held by her mother, is kicking, screaming, and flailing her arms about.Which nursing diagnosis related to this patient is the most critical?
A)Anxiety and fear related to venipuncture
B)Risk for injury, bleeding, hematoma, or infection related to venipuncture
C)Pain related to venipuncture
D)Risk for impaired skin integrity

Accepted Answer

The most critical nursing diagnosis in this situation is the risk for injury, bleeding, hematoma, or infection related to venipuncture. The child's active resistance increases the risk for unintentional injury that the nurse must prevent. It is essential to explore strategies to minimize the risk of injury and ensure a safe venipuncture procedure. Although anxiety, fear, and pain are common in venipuncture procedures, they are not the most critical in this scenario. The risk for impaired skin integrity is also not the most critical nursing diagnosis.

Question 11

A patient diagnosed with prostatic hypertrophy has a suprapubic catheter to manage chronic urinary retention.A urine culture shows a bacterial colony count of less than 100,000 organisms/mL.Which intervention by the nurse is appropriate?
A)Begin sterile saline flushes of the catheter twice daily until a repeat culture is negative.
B)Encourage adequate intake of fluids to maintain clear, yellow urine.
C)Inform patient that antibiotics will be started as soon as requesting health-care provider writes the order.
D)Plan to insert a new suprapubic catheter as soon as possible.

Accepted Answer

A bacterial colony count of less than 100,000 organisms/mL is considered a low level of bacteria and may not require antibiotic treatment. Encouraging adequate fluid intake can help maintain good urine output and clear, yellow urine. Option A is not necessary since the colony count is low and sterile saline flushes may increase the risk of infection. Option C should not be done without an order from the healthcare provider for antibiotics. Option D is not necessary unless there are other complications with the current catheter.

Question 12

A patient with a history of metastatic breast cancer asks about testing for the presence of human epidermal growth factor receptor 2 (HER-2/neu oncoprotein).A nurse should instruct the patient that this test will require a:
A)Blood specimen drawn in the early morning
B)Tissue sample obtained by needle biopsy of the breast
C)Tumor sample from the excision of a metastatic site
D)Urine specimen collected over 24 hours

Accepted Answer

The best way to test for the presence of HER-2/neu oncoprotein is by obtaining a tissue sample through needle biopsy of the breast. This is the most accurate and reliable method of testing for HER-2/neu status in breast cancer patients. Blood testing is not helpful in this case, and a tumor sample from an excision of a metastatic site is not necessary for HER-2/neu testing. Urine testing is not a valid method for testing for HER-2/neu status.

Question 13

A postmenopausal patient is treated for a vertebral fracture.The patient states, "I did not even fall or remember doing anything to cause an injury like this." The patient has a bone mineral densitometry (DEXA)T-score of -3.6.What significant health history should the nurse identify that relates to this clinical presentation?
A)History of gastric reflux managed with medication
B)Lacto-ovo vegetarian diet
C)Lifelong, active participation in sports activities
D)Onset of menopause at 58 years

Accepted Answer

A history of gastric reflux managed with medication is significant because certain medications used to treat gastric reflux, such as proton pump inhibitors (PPIs), can decrease calcium absorption in the stomach, leading to increased risk of osteoporosis and fractures.

Question 14

Prior to a scheduled laboratory blood draw for serum aldosterone level, a nurse should instruct a patient to:
A)Decrease potassium in the diet at least 48 hours prior to the test.
B)Increase fluid intake during the 24 hours prior to the test.
C)Remain in either a supine or upright position for at least 2 hours prior to the test.
D)Restrict sodium in the diet for 1 week prior to the test.

Accepted Answer

DAldosterone levels can be influenced by body position and sodium intake. Remaining in a consistent position (supine or upright) for at least 2 hours prior to the test helps standardize the results, as aldosterone levels can vary with changes in posture. Restricting sodium in the diet for a week prior to the test can help in assessing the body's aldosterone response to sodium intake, as aldosterone plays a key role in sodium regulation in the body.

Question 15

A gastric acid stimulation test indicates that a patient has gastroparesis.Which teaching should a nurse plan for this patient?
A)Eat small, frequent meals that are low fat and low fiber.
B)Increase fiber in the diet, with at least 64 ounces of water daily.
C)To promote gastric emptying, avoid activity for 2 hours after eating.
D)Parenteral nutrition will be necessary, so a peripherally inserted central line will be inserted.

Accepted Answer

Gastroparesis is a condition where food moves slowly or not at all from the stomach to the small intestine. Eating small, frequent meals that are low in fat and fiber can help improve symptoms of gastroparesis by facilitating gastric emptying. High-fiber foods can slow down the digestion process, making symptoms worse. Increasing activity can also promote gastric emptying. Parenteral nutrition is not always necessary and would only be considered in severe cases.

Question 16

A patient has had a heart attack and needs to undergo testing to evaluate the resulting damage to the myocardium.Which test would be most appropriate for this purpose?
A)Thyroxine, free
B)Triiodothyronine, free
C)Thyroid-stimulating immunoglobulins (TSI)
D)Troponins I and T

Accepted Answer

Troponins I and T are released into the bloodstream when there is damage to the myocardium, making them a sensitive and specific marker for a heart attack. Thyroxine, free, triiodothyronine, free, and thyroid-stimulating immunoglobulins (TSI) are tests related to thyroid function and not indicators of cardiac damage.

Question 17

A patient with a family history of glaucoma is advised to have pachymetry.The nurse should explain that the purpose of this test is to:
A)Assess collateral structures in the eye
B)Evaluate visual acuity without using dilating drops
C)Measure the thickness of the cornea
D)Obtain a more accurate measure of intraocular pressure

Accepted Answer

Pachymetry is a test used to measure the thickness of the cornea, which is an important factor in accurately measuring intraocular pressure. A thin cornea can give false low readings on intraocular pressure tests, while a thick cornea can give false high readings. Knowing the accurate thickness of the cornea is crucial in diagnosing and managing glaucoma, especially in patients with a family history of the condition.

Question 18

A nurse is assisting with a thyroid biopsy.After the tissue sample is obtained, the nurse should place it in a container with which of the following?
A)Saline
B)Formalin solution
C)Heparin
D)EDTA

Accepted Answer

Formalin solution is commonly used as a fixative for tissue samples. It preserves the tissue and prevents decay, making it ideal for biopsy samples. Saline, heparin, and EDTA are not appropriate for this purpose.

Question 19

Which laboratory result should a nurse anticipate as part of an initial screening for a patient who is being evaluated for iron-deficiency anemia?
A)Iron
B)Serum ferritin
C)Total iron-binding capacity
D)Transferrin saturation

Accepted Answer

Serum ferritin is a direct marker of the amount of iron stored in the body and is typically low in iron-deficiency anemia, making it a crucial part of initial screening for this condition.

Question 20

An adult patient's laboratory test results indicate a normal arterial oxygen saturation.Which of the following oxygen saturations is normal?
A)85%
B)89%
C)93%
D)97%

Accepted Answer

A normal arterial oxygen saturation for an adult is between 95-100%, and option D is the only answer within that range. Options A, B, and C all fall below the normal range and indicate various degrees of hypoxemia.

Quiz 2: Preface

A nurse is scheduling a laboratory appointment for a patient who needs to have blood drawn for adrenocorticotropic hormone (ACTH) levels.The best time for this test is:

A 90-year-old patient has a carotid duplex ultrasound that shows stenosis of 40% to 60% and a moderate amount of plaque.Which nursing action is most appropriate for this patient?

A geriatric patient asks a nurse about the significance of a bone mineral densitometry (DEXA) T-score measurement of -0.75.What response by the nurse is most accurate?

Prior to beginning a urine collection for catecholamine, a nurse should instruct a patient to:

Which instruction should a nurse provide to a patient in preparation for a gastric acid stimulation test?

A patient's arterial blood gases are pH 7.29, HCO₃-24 mEq/L, PO₂ 74, PCO₂ 52 mm Hg.A nurse assessing this patient should observe for signs and symptoms of:

When collecting any specimen for laboratory analysis, what should be a nurse's first priority?

One hour after starting a unit of packed red blood cells, a nurse observes that a patient receiving the transfusion is reporting flank pain and has a temperature of 101.8 $\degree$ F (38.8 $\degree$ C) .The nurse's first action should be to:

A nurse is attempting to insert a needle to obtain a blood specimen from a 4-year-old, but the child, who is being held by her mother, is kicking, screaming, and flailing her arms about.Which nursing diagnosis related to this patient is the most critical?

A patient diagnosed with prostatic hypertrophy has a suprapubic catheter to manage chronic urinary retention.A urine culture shows a bacterial colony count of less than 100,000 organisms/mL.Which intervention by the nurse is appropriate?

A patient with a history of metastatic breast cancer asks about testing for the presence of human epidermal growth factor receptor 2 (HER-2/neu oncoprotein) .A nurse should instruct the patient that this test will require a:

Prior to a scheduled laboratory blood draw for serum aldosterone level, a nurse should instruct a patient to:

A gastric acid stimulation test indicates that a patient has gastroparesis.Which teaching should a nurse plan for this patient?

A patient has had a heart attack and needs to undergo testing to evaluate the resulting damage to the myocardium.Which test would be most appropriate for this purpose?

A patient with a family history of glaucoma is advised to have pachymetry.The nurse should explain that the purpose of this test is to:

A nurse is assisting with a thyroid biopsy.After the tissue sample is obtained, the nurse should place it in a container with which of the following?

Which laboratory result should a nurse anticipate as part of an initial screening for a patient who is being evaluated for iron-deficiency anemia?

An adult patient's laboratory test results indicate a normal arterial oxygen saturation.Which of the following oxygen saturations is normal?