Diagnostic Testing Flashcards
What is the insertion of a needle directly into the vein?
Venipuncture
What is removing fluids from the peritoneal cavity?
Paracentesis
What are soft tissue radiographs that allow visualization of the underlying breast tissue?
Mammogram
What is removing a larger collection of cells like a tumor or mass, which may be used to detect skin, breast, or liver cancer?
Biopsy
What is a radiological procedure in which a special scanner allows cross-sectional images of an organ to be visualized?
Computed Tomography (CT Scan)
What is the use of a superconducting magnet and radiofrequency waves that cause hydrogen nuclei to emit signals?
Magnetic Resonance Imaging (MRI)
What procedure visualizes soft tissue organs by recording and measuring the reflections of sonic waves?
Ultrasound
What removes fluid from the pleural space?
Thoracentesis
What contains chemically altered filter paper that changes color when stool containing blood is placed on it?
Hemoccult
What is a recording of the electrical current generated by the heart during depolarization and repolarization of the cardiac muscle?
Electrocardiogram
What are the components of a complete blood count (CBC)?
Red blood cell (CBC)
Hemoglobin
Hematocrit (HCT)
Red cell indices
White blood cell (WBC)
Differential WBC
The nurse anticipates that testing will be done for the patient who is taking an anticoagulant. What specific tests may be ordered to assess this patient’s status?
Platelets
Bleeding time
Prothrombin time/internal normalized ratio (PT/INR
Activated partial thromboplastin time
Fibrinogen
Glucose testing is done to determine the presence of which condition?
Diabetes Mellitus
What is known by patients as the “good” cholesterol?
High-density lipoprotein (HDL) is the “good” cholesterol, and (LDL) is the “bad” cholesterol.
What are “normal” expected values from a urinalysis?
Clear to slightly hazy
Negative protein
pH 6
C-reactive protein (CRP) is used as a marker for which disorders?
Inflammatory and autoimmune disorders such as rheumatoid arthritis, lupus, and inflammatory bowel syndrome (IBS). Hi-sensitivity CRP marker for vascular inflammation. CRP is now used to screen for coronary artery disease and predict future cardiac events.
What cardiac markers (tests) might be ordered for a patient to check for cardiac tissue damage?
Myoglobin
Troponin T
Creatine kinase
What is associated with black and tarry stools?
Bleeding in the upper GI tract.
Bright red bleeding is associated with bleeding in the lower GI tract.
Which test is done to check for tapeworm, and how must the sample be sent to the lab?
Fecal ova and parasite is the test done. The sample must be sent to the lab while still warm. 1 inch of solid stool or 15 to 30 ml of liquid stool needed.
How would you explain a culture and sensitivity test to a patient?
A specimen (urine, blood, sputum, etc.) is sent to the lab for a suspected infection. It is a positive result if bacteria are found, and different antibiotics are considered the best treatment for that specific bacteria.
What is the most critical area to monitor during a bronchoscopy?
Respiratory status
What nursing care should be provided for patients after a thoracentesis?
- Position the patient on the UNAFFECTED side for at least one hour.
- Monitor vital signs
- Check dressing
- Check the puncture site for bleeding or crepitus (a crackling or popping sensation indicating air leaks and trapped under the skin).
- Assess respiratory status (breath sounds, symmetry, and signs of distress)
- Chest x-ray if ordered
What nursing care should be provided for patients after a Lumbar puncture?
- Instruct patient to lie flat for 4 to 8 hours.
- Encourage fluids
- Perform neurological assessment
- Assess the puncture site for drainage/bleeding
- Administer pain meds (analgesics) as needed.
What nursing diagnosis/hypothesis and goal/outcome can be identified for a patient who is extremely anxious about a diagnostic test that must be performed?
Diagnosis: Anxiety associated with diagnostic testing as evidenced/manifested by fidgeting, pacing, facial expression, and rapid heart rate.
Goal: Patient will discuss areas of concern about testing. Patient will use relaxation techniques and demonstrate decreased anxiety while waiting for the testing.
What color stoppers on blood collection tubes should be used for blood chemistry and blood culture?
Yellow = Blood culture
Red = Blood chemistry (CMP)
Light blue = Coagulation tests
Lavender = Hematology tests (CBC)
Red/black/green = Stat chemistry
What are three national patient safety goals for patients having diagnostic tests?
- Two patient identifiers are used
- Patient room number or physical location is NOT used as an identifier
- Label lab containers in front of the patient
What standard precautions are used for venipuncture?
- Handwashing before and after
- Gloves are worn for the entire procedure
- Sharps disposed of immediately when done
What standard precautions are used for urine collection?
- Handwashing before and after
- Gloves are worn for the entire procedure
- Specimen is stored in a plastic bag/biohazard container to take to the lab.
What can nurses do to support and comfort patients during a procedure?
- Assist patient with the necessary position.
- Pad bony prominences
- Explain what is being done
- Offer emotional support/hold their hands
How do we carefully manage the collection and transfer of specimens?
- Careful specimen collection
- Handled with aseptic technique
- Identified and place in correct container for transport to lab
What are the steps in the correct order when providing instructions to a female patient for a “clean catch” urine specimen?
- Prepare sterile specimen cup
- Cleanse the perineum front to back, repeating with new wipes
- Separate the labia
- Urinate a small amount into the toilet
- Place the cup into the urine stream and collect 30 mL of urine
- Finish urinating, close and wipe off the container
How can you troubleshoot a glucometer that is not providing accurate results?
- Ensure hands were washed
- Assess for signs and symptoms of hypoglycemia and hyperglycemia
- Verify the time of the last meal or insulin dose
- Ensure that an adequate sample was obtained
- Check the strip codes match the meter
- Verify the last calibration.
- Check the meter with control samples
- Make sure that batteries are charged
When is a sputum collection typically ordered?
- Infectious respiratory disease is suspected, such as pneumonia or tuberculosis.
- Evaluate the effectiveness of antibiotics/antiviral therapy treatment
- Identify present of abnormal tumor cells
What are the correct steps for sputum collection?
- Sample should be collected first thing in the morning
- Oral care is provided before and after
- A specimen of 2 to 10 mL is needed.
- Patient expectorates directly into the container
What do you do when a patient gags during a throat culture?
Instruct them to sit upright and say, “Ahhh”, place the swab off-center, and swab quickly
What assessment should be included before most diagnostic procedures?
- Check patient ID band and make sure it is correct
- Review medical record for history for being high risk
- Check for allergies to food or medications. If patient will have procedure with iodine contrast, check for history of adverse reactions or allergy to iodine food (shellfish)
- Check that consent form is signed and witnessed
- Get baseline vitals
- Check with MD if any routine meds are allowed to take before procedure
- When needed, ensure patient has been NPO
- Ensure if any prep were taken if needed (laxatives)
- Ig procedure needs IV access, make sure patient has IV and it is patent (working well)
- If pre-procedure sedative was ordered, give it on time and make sure emergency equipment is nearby
What should be monitored after most procedures?
Assess vital signs, airway, oxygenation status, and site of the procedure for bleeding.
What do the following patient lab results indicate? 1) Female with RBCs = 3.7, 2) Child with WBC 8000, 3) Platelets 75,000, and D) BUN 30.
- RBCs low - could be due to anemia, bone marrow suppression, chronic infection, hemorrhage, renal disease, vitamin B or folic acid deficiency
- WBC within normal limits
- Platelet low: due to anemia, transfusion of packed cells, HIV infection, chemo/radiation therapy.
- BUN increased: due to acute glomerulonephritis (kidneys), congestive heart failure, diabetes, high protein diet, nephrotic syndrome, renal disease, severe dehydration, severe infection, and shock.
What does a CT scan on the brain diagnose?
Diagnose abscess, cerebral infarction (stroke), aneurysm, hemorrhage, hydrocephalus, and tumor.
Which test(s) are used to verify Chron’s disease?
Sigmoidoscopy or Colonoscopy
How do you collect a stool specimen when multiple specimens are required?
- Place a sign on the patient’s bathroom and the patient’s health record
- Remind patient that samples are needed
- Communicate information in the report and document
- Remove the sign when the last sample is collected
How do you collect a stool specimen when the sample is mixed with toilet paper, toilet water, or body fluid?
Do not use - collect a new sample.
Which lab findings indicate the patient has diabetes under control?
hgb A1c = 4 to 5.7% (normal)
hgb A1c greater than 6.5 = Diabetes *hgb A1c is the average blood glucose levels for the past 3 months.
What is found in higher amounts when jaundice is present?
Bilirubin
What is the correct technique for collecting specimen for blood glucose monitoring?
Calibrating the meter to the strip for accurate results.
What technique should be used for collecting urine specimens for urinalysis from a patient with an indwelling catheter?
Clamp the drainage tubing for 10 to 30 mins before specimen collection begins.
What technique should be used for collecting urine specimen from a mid-stream sample?
Voiding some urine first and then collecting the sample
What medication is taken regularly should concern the nurse for continued bleeding after a venipuncture?
- Aspirin (analgesic/pain and anticoagulant)
- warfarin
- heparin
l4. ovonox
Apply pressure to the site for at least 3 to 5 minutes after removing the needle.
What is hemoccult testing?
The strip changes color when blood is found.
A lumber puncture is ordered when what disease is suspected?
Meningitis
What test is used to determine liver function?
Alkaline phosphatase
What is a possible complication of a cystoscopy (scoping the bladder)?
Hematuria (blood in urine)
What is the plan of care for a patient after an arthroscopy of the left knee (post-procedure?
- Assess the neurovascular status of the affected limb for pain, pallor, paresthesia, paralysis, and pulse
- Monitor vitals
- Elevate the extremity and apply ice
- Admisiter analgesic for pain prn
- Avoid alcohol for 24 hours
What does the nurse anticipate as the primary need for the patient after the arthroscopy (joint surgery)?
Pain management with an analgesic as ordered, and made sure the leg was positioned correctly.
What disorders can be diagnosed with a chest radiograph (Chest X-ray)?
- Pulmonary/lung disorders such as tuberculosis, cancer, and pneumonia
- Cardia/heart enlargement
- Determine the correct placement of treatment devices such as chest tubes, central lines, and pacemakers.
What might the patient experience if they develop a rash and do not feel well after a diagnostic test that used contrast media? What should have been assessed before the test?
- Suspicious of an allergic reaction and may progress to anaphylaxis.
- Patient should be asked about allergies to seafood, iodine, or dye
- Lab values such as BUN, creatine, and creatine clearance should be checked to determine kidney function, which is needed to excrete the contrast dye.
Which tests require patients to be fasting?
Cholesterol
Low-density lipoprotein (LDL)
High-density lipoprotein (HDL)
What instructions are important for patients having an MRI?
- MRI is contraindicated for patients with older pacemakers, implanted medication pumps, inner-ear implants, fragments from gunshot wounds, or any other metal object in the body.
- All jewelry should be removed before the test.
- Clusterphoephic patients might need a sedative to decrease anxiety.
- On rare occasions, people with tattoos might experience burning or swelling in those areas after an MRI.
What should screenings for colorectal cancer for individuals older than 45 years include?
- Fecal occult blood, sigmoidoscopy every 5 years, or colonoscopy every 10 years for adults with average risk beginning at age 45.
- DNA testing with patient stool is a newer test.
What is ultrasound commonly used to determine?
- Status of the fetus for pregnant women
- Abnormal organ growth, lesions, or tumors
What question is important to ask young and middle-aged female patients who are having diagnostic tests?
Any chance they might be pregnant? When was the last menstrual period?
What is the normal Hemoglobin level?
Male = 14 to 18
Female = 12 to 16
What is the normal WBC level?
Adult 5000 to 10,000
What is the normal Platelet level?
150,000 to 400,000
What is the normal Sodium level?
136 to 145
What is the normal Potassium level?
3.5 to 5
What is the normal Total cholesterol level?
Less than 200
What procedure involves inserting a needle or catheter into the chest wall to remove fluid or air from the pleural space between the lungs and the chest wall?
Thoracentesis
What is the normal Glucose level?
74 to 106
What is the normal Blood Urea Nitrogen (BUN)?
10 to 20
What are the normal CRP levels?
Less than 1 = normal/low risk
Above 3 = high risk
What is steatorrhea?
Fecal fat/fatty stool due to failure to digest and absorb fat. Related to malabsorption syndrome, lack of pancreatic enzyme, or lack of bile.
What is the normal urine specific gravity?
1.005 to 1.030
What does it mean if the urine is positive for ketones (ketosis)?
Commonly related to fasting, burning fat, high protein diet
What is an important safe practice alert for nurses to assess?
Assess the patient for allergies to seafood, iodine, and contrast dye, as well as their lab values (BUN, creatinine) to assess kidney function for the ability to excrete the contrast dye.
What are safe practice alerts for informed consent?
The nurse must check that the consent form is signed BEFORE any pre-procedure sedatives or narcotics are administered.
What is the process for collecting a timed-specific urine collection?
The patient must void first and then start collecting urine after the first voiding for a specific time frame as ordered ( 1 to 24 hours).
What are the types of cells found in the blood?
- Erythrocytes which contain hemoglobin
- Thrombocytes, which are needed for blood clotting
- Leukocytes are needed for inflammatory and immune response.
What are the most common blood tests ordered?
CBC, coagulation studies, blood chemistries, liver and kidney function tests, and cardiac markers.
What are the normal hematocrit levels?
42% to 52% for males
37% to 47% for females
What INR levels are therapeutic for a patient taking an oral anticoagulant (warfarin)?
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. An INR level of 5.9 is dangerously high and puts the client at risk for bleeding.
What is the correct sequence for obtaining capillary blood glucose?
- Ensure that hands are washed.
- Select the site and put on gloves.
- Cleanse the site with alcohol and allow to dry.
- Quickly puncture the skin with the lancet.
- Wipe away the first drop of blood with gauze.
- Cover the test strip with full blood sample.
What are the normal levels of HDL cholesterol?
> 45 mg/dL for males and
55 mg/dL for females.
What is the normal level for triglycerides?
Triglycerides reflect dietary intake and risk of cardiovascular disease.
<160 mg/dL for males and
<135 mg/dL for females.
What are the normal levels of LDL cholesterol?
< 130 mg/dL
What are some patient teaching for a barium swallow test?
- The doctor will be able to view the stomach and intestines during the test
- Pt should increase fluids after the test
- Pt will have to drink a contrast agent
- Barium can cause constipation and pt may need a mild laxative. Stools may turn white for a few days as the barium is expelled.
Which patient specimens should be collected by the nurse using a sterile technique in a sterile container?
- Clean-catch urine
- Wound drainage
- Sputum
- Urine from a Foley catheter
Which stool specimen collection should be collected using a sterile procedure?
Stool for culture needs to be collected in a sterile container.
Note: stool for occult blood does NOT need to be sterile.
Which blood test is expected to be elevated in a patient with chronic renal failure?
Creatinine
For which patient is magnetic resonance imaging (MRI) contraindicated?
A patient with an inner ear implant which can be pulled out of position by the strong magnetic force.
What are the expected treatments for a patient with a positive guaiac stool (blood in stool)?
Colonoscopy performed (a type of endoscopy).
Upper endoscopy may also be performed to look for possible upper GI bleeding.
