Slide 1

NCLEX Review Adult Health~ 52 Selected Lab & Diagnostic Tests QuestionsNursing Considerations & SafetyQuestions and Answershttp://usnnursing.pbworks.com/http://nursing--pharmacology.pbworks.com/11. A clients laboratory results reveal a hemoglobin of 6 g/dL. Which foods should be encouraged for this client?Broiled fishWhole grainsDried fruitsSteamed vegetables

2With a low hemoglobin, the oxygen-carrying capacity of the blood is diminished resulting in client fatigue. The preserving agent for dried fruits adds iron, making the fruits excellent sources for this mineral.

1. A clients laboratory results reveal a hemoglobin of 6 g/dL. Which foods should be encouraged for this client?Broiled fishWhole grainsDried fruitsSteamed vegetables

Normal Hgb range ~ 14-17 g/dl32. Which nursing diagnosis is most appropriate for a female adult client with a hemoglobin of 12.0 mg/dL and a hematocrit of 29%?Fluid volume excessDecreased tissue perfusionImpaired tissue integrityRisk for activity intolerance42. Which nursing diagnosis is most appropriate for a female adult client with a hemoglobin of 12.0 mg/dL and a hematocrit of 29%?Fluid volume excessDecreased tissue perfusionImpaired tissue integrityRisk for activity intolerance

Hemoglobin is normal. Hematocrit should be 3 times the hemoglobin. If it is less than that, it indicates over hydration or hemodilution.

Normal Hgb range ~ 14-17 g/dl Normal Hct ~ 36-50% (males higher than females)53. The reticulocyte count is elevated in a client with recent blood loss due to severe skin laceration. In planning care, the RN anticipates which physician order?Maintain fluid intake at 2-3 liters per dayObtain consent for bone marrow biopsyInstitute iron restricted dietPrepare client for plasmaphoresis63. The reticulocyte count is elevated in a client with recent blood loss due to severe skin laceration. In planning care, the RN anticipates which physician order?Maintain fluid intake at 2-3 liters per dayObtain consent for bone marrow biopsyInstitute iron restricted dietPrepare client for plasmaphoresis

A. Increased reticulocyte count is normal after blood loss or in anemia. It indicates the bone marrow is working to replace lost RBCs by producing immature RBCs and sending them into the circulation.74. Which statement would be true of platelets?Are formed and stored in the spleenRepair damage to small blood vesselsCause red blood cells to clump forming clotsCirculate for 4-6 weeks before dying84. Which statement would be true of platelets?Are formed and stored in the spleenRepair damage to small blood vesselsCause red blood cells to clump forming clotsCirculate for 4-6 weeks before dying

Platelets repair damage to small blood vessels. They are formed in the bone marrow but are stored in the spleen and clump together to form clots. They live 1-2 weeks. Normal count = 150,000-450,00095. Which is an explanation for a shift-to-the-left in the neutrophil count?Stem cells are being over producedBone marrow is releasing fewer mature cells into the circulating bloodBone marrow is responding to overproduction of lymphocytesThe thymus gland is unable to produce T-cells105. Which is an explanation for a shift-to-the-left in the neutrophil count?Stem cells are being over producedBone marrow is releasing fewer mature cells into the circulating bloodBone marrow is responding to overproduction of lymphocytesThe thymus gland is unable to produce T-cells

B. This is the only response related to neutrophil shift-to-the-left.116. Which of these clients should the nurse assess first?Hemoglobin level of 15.9 g/dLCoumadin with a prothrombin time (PT) of 35.6 secondsTotal calcium level of 9.4 mg/dLBUN of 30 mg/dL and creatinine of 1.1 mg/dL

126. Which of these clients should the nurse assess first?Hemoglobin level of 15.9 g/dLCoumadin with a prothrombin time (PT) of 35.6 secondsTotal calcium level of 9.4 mg/dLBUN of 30 mg/dL and creatinine of 1.1 mg/dL

Normal prothrombin time is 126 mg/dL is diagnostic).4724. A 16-year-old client with type I Diabetes Mellitus is sporadically non-compliant with diet and todays FBS was 116 mg/dL. Which glycosylated hemoglobin would indicate a need for more teaching?Hgb A1C is 2.5%Hgb A1C is 6.5%Hgb A1C has increased from 5.9% to 7.9%Hgb A1C has dropped from 4% to 2.5%4824. A 16-year-old client with type I Diabetes Mellitus is sporadically non-compliant with diet and todays FBS was 116 mg/dL. Which glycosylated hemoglobin would indicate a need for more teaching?Hgb A1C is 2.5%Hgb A1C is 6.5%Hgb A1C has increased from 5.9% to 7.9%Hgb A1C has dropped from 4% to 2.5%

C. Normal Hgb A1C for a diabetic in good control is 6-7%. An increase of 2% and over the normal indicates a need for more teaching.4925. A pregnant client at 28 weeks gestation has a fasting 1 hour glucose challenge test with a result of 156 mg/dL. Which would be the best response by the nurse?Tell her she has diabetes mellitus and plan teachingOrder a 3 hour glucose tolerance test per protocolContinue to monitor her as this is normalContinue to monitor the elevated placental lactogen5025. A pregnant client at 28 weeks gestation has a fasting 1 hour glucose challenge test with a result of 156 mg/dL. Which would be the best response by the nurse?Tell her she has diabetes mellitus and plan teachingOrder a 3 hour glucose tolerance test per protocolContinue to monitor her as this is normalContinue to monitor the elevated placental lactogen

B. If the GCT is above 140 mg/dL, a 3 hour GTT is indicated. Also, it should be done non-fasting.5126. The nurse is asked to collect a sample of exudate from a clients wound for a culture and sensitivity. What procedure would be best?Irrigate the wound and then collect samplePlace sample in sterile container for transportStart the ordered antibiotic and then collect sampleSwab the skin around the wound to collect sample5226. The nurse is asked to collect a sample of exudate from a clients wound for a culture and sensitivity. What procedure would be best?Irrigate the wound and then collect samplePlace sample in sterile container for transportStart the ordered antibiotic and then collect sampleSwab the skin around the wound to collect sample

B. All specimens must be collected using sterile methods and placed in a sterile container. Antibiotics should be started after specimen collection.5327. Which client would the nurse send for an MRI without questioning the order? A.Diabetic with an implanted insulin pumpB.Pregnant primigravida at 34 weeks gestationC.Client with heart failure and a pacemakerD.Auto accident victim on life support systems5427. Which client would the nurse send for an MRI without questioning the order?A.Diabetic with an implanted insulin pumpB.Pregnant primigravida at 34 weeks gestationC.Client with heart failure and a pacemakerD.Auto accident victim on life support systems

B. Pregnancy is not a contraindication for MRI. The other options have equipment containing metal which would cause the MRI equipment to malfunction.5528. Which consideration would be least important when a client is to have computed tomography (CT) scan with contrast medium?Client has Huntington diseaseClient has chronic renal failureClient had hives following an IVPClient ate lunch 5 hours ago5628. Which consideration would be least important when a client is to have computed tomography (CT) scan with contrast medium?Client has Huntington diseaseClient has chronic renal failureClient had hives following an IVPClient ate lunch 5 hours ago

D. Clients are usually NPO for no more than 4 hours before the test. The client must lie still and must be able to clear the contrast medium without reacting negatively to it.5729. What follow-up care is needed for a client with PAP(Papanicolaou test) results of "atypical squamous cells of undetermined significance (ASCUS)?A. Normal report and requires no special follow-upB. Indicates cancerous cells; client will have an immediate colonoscopyC. Abnormal report; client will need follow-up evaluationD. Indicates cancerous cells; client will require a hysterectomy

58C. This is not a normal report and indicates that further information is needed before a diagnosis of cancer is made.

29. What follow-up care is needed for a client with PAP (Papanicolaou test) results of "atypical squamous cells of undetermined significance (ASCUS)?A. Normal report and requires no special follow-upB. Indicates cancerous cells; client will have an immediate colonoscopyC. Abnormal report; client will need follow-up evaluationD. Indicates cancerous cells; client will require a hysterectomy

5930. A 42-year-old female client asks the RN when she should have a mammogram. What is the RNs best reply based on current American Cancer Society recommendations?Have a baseline mammogram between age 40 and 45.Begin having annual mammograms now.Begin having annual mammograms at age 50.Begin having mammograms every other year now.

6030. A 42-year-old female client asks the RN when she should have a mammogram. What is the RNs best reply based on current American Cancer Society recommendations?Have a baseline mammogram between age 40 and 45.Begin having annual mammograms now.Begin having annual mammograms at age 50.Begin having mammograms every other year now.

B. According to the American Cancer Society, women should begin having annual mammograms at age 40.6131. Which client statement indicates a need for further teaching regarding a mammogram?I will not bathe on the morning of the procedure.I will not apply deodorant before the procedure.I will experience some discomfort from the compression of the tissue during the procedure.I will be asked to remove my clothing from the waist up prior to this procedure.6231. Which client statement indicates a need for further teaching regarding a mammogram?I will not bathe on the morning of the procedure.I will not apply deodorant before the procedure.I will experience some discomfort from the compression of the tissue during the procedure.I will be asked to remove my clothing from the waist up prior to this procedure.

A. Clients may bathe before a mammogram. However, they should be instructed not to wear lotions, powders, or deodorants as these may contain metallic salts.6332. What is the rationale for including the step of inspection of the breasts with the arms raised above the head when performing breast self examination?Facilitates inspection of axillary lymph nodesTriggers spontaneous nipple dischargeElevates nipple and areolar areaReveals changes in breast contour and symmetry6432. What is the rationale for including the step of inspection of the breasts with the arms raised above the head when performing breast self examination?Facilitates inspection of axillary lymph nodesTriggers spontaneous nipple dischargeElevates nipple and areolar areaReveals changes in breast contour and symmetry

D. Changes in shape or contour are emphasized when the arms are raised over the head.6533. How would the nurse best teach a client about an endometrial biopsy?Will require an overnight hospital stayA tube will be inserted into the uterus through the abdomenThere will be cramping during the procedureA magnifying instrument will allow tissue visualization6633. How would the nurse best teach a client about an endometrial biopsy?Will require an overnight hospital stayA tube will be inserted into the uterus through the abdomenThere will be cramping during the procedureA magnifying instrument will allow tissue visualization

C. There will be cramping when the biopsy is taken. The procedure is done in an office or clinic by placing a tube thru the cervix into the uterine body. Tissue is not visualized.6734. A colposcopy is scheduled for a client. In reviewing the clients chart, which would the RN expect in the history?History of infertilityHistory of abnormal PAP smearFamily history of ovarian cancerHistory of cervical laceration6834. A colposcopy is scheduled for a client. In reviewing the clients chart, which would the RN expect in the history?History of infertilityHistory of abnormal PAP smearFamily history of ovarian cancerHistory of cervical laceration

B. Colposcopy is used to locate the exact site of precancerous and malignant lesions for tissue biopsy following an abnormal PAP smear.6935. A client had a laparoscopic tubal ligation this morning. Which nursing diagnosis has the highest priority?Pain related to CO2 insufflationActivity intolerance related to post-anesthesia fatigueRisk for infection related to surgical incisionRisk for altered tissue perfusion related to surgical procedure7035. A client had a laparoscopic tubal ligation this morning. Which nursing diagnosis has the highest priority?Pain related to CO2 insufflationActivity intolerance related to post-anesthesia fatigueRisk for infection related to surgical incisionRisk for altered tissue perfusion related to surgical procedure

A. Carbon dioxide gas is used to separate the internal structures for better visualization and the remaining gas stimulates the diaphragm resulting in left shoulder pain.7136. A teenage client who is scheduled for a lumbar puncture, was told by friends that the brain sinks when cerebrospinal fluid is removed. Choose the best response by the nurse to lower anxiety levels.

Removing the small amount of CSF during the procedure has absolutely no effect on the brain.The amount of CSF removed will be rapidly replaced by the body.The body has more fluid than is necessary and the amount removed is insignificant.The physician will monitor the CSF pressure closely during the procedure to minimize any danger.

7236. A teenage client who is scheduled for a lumbar puncture, was told by friends that the brain sinks when cerebrospinal fluid is removed. Choose the best response by the nurse to lower anxiety levels.Removing the small amount of CSF during the procedure has absolutely no effect on the brain.The amount of CSF removed will be rapidly replaced by the body.The body has more fluid than is necessary and the amount removed is insignificant.The physician will monitor the CSF pressure closely during the procedure to minimize any danger.

Clarification of how the body works is reassuring to the client.

7337. Which statement would best assist a client to prepare for a cerebral angiogram?This X-ray will help assess the circulation around your heart.You will have a regular breakfast before the test.A contrast dye will be injected to help visualize the blood vessels.The catheter will be inserted in your left arm close to the heart.

7437. Which statement would best assist a client to prepare for a cerebral angiogram?This X-ray will help assess the circulation around your heart.You will have a regular breakfast before the test.A contrast dye will be injected to help visualize the blood vessels.The catheter will be inserted in your left arm close to the heart.

A contrast dye will be inserted through the groin to visualize the vessels in the brain. Clients are either NPO or have only clear liquids 6-8 hours before the procedure.7538. Which statement would be representative of a normal electrocardiogram (EKG)?QRS complex of .08 secondsPR interval of .05 secondsP wave of .14 secondsTotal heart beat of 4 seconds

7638. Which statement would be representative of a normal electrocardiogram (EKG)?QRS complex of .08 secondsPR interval of .05 secondsP wave of .14 secondsTotal heart beat of 4 seconds

The normal QRS complex is .06-.10 seconds. PR interval should be .12-.20 seconds and P wave should be less than .11 seconds. The normal heart beat is about .20-.40 seconds.7739. The nurse is reviewing laboratory tests of a client who was admitted with chest pain. Which result should the nurse report to the physician immediately?

Elevation in serum troponin levelDecrease in serum troponin levelElevation in blood urea nitrogen levelDecrease in serum creatinine level

7839. The nurse is reviewing laboratory tests of a client who was admitted with chest pain. Which result should the nurse report to the physician immediately?

A. Elevation in serum troponin levelB. Decrease in serum troponin level C. Elevation in blood urea nitrogen levelD. Decrease in serum creatinine level

A.Cardiac troponin is virtually undetectable in the serum of healthy people, but rises to a detectable level within 1 hour of myocardial injury. It is especially useful in the early diagnosis of acute MI and in detection of silent MI.

7940. During a treadmill stress test, a middle-aged client becomes extremely diaphoretic and complains of pressure in the mid-chest. The nurse notes the ST segment is elevated on the EKG. What is the nurses first action?Offer a glass of cool water to help replace fluid lost by sweatingHave the client take a break and give the morning dose of digoxin (Lanoxin)Continue the test at a slower rate and notify the physicianStop the test, have the client sit or lie down and assess vital signs

8040. During a treadmill stress test, a middle-aged client becomes extremely diaphoretic and complains of pressure in the mid-chest. The nurse notes the ST segment is elevated on the EKG. What is the nurses first action?Offer a glass of cool water to help replace fluid lost by sweatingHave the client take a break and give the morning dose of digoxin (Lanoxin)Continue the test at a slower rate and notify the physicianStop the test, have the client sit or lie down and assess vital signs

D. These symptoms and EKG changes may indicate the onset of an MI and any farther activity will worsen the condition.

8141. The nurse is teaching a client who is scheduled for 24-hour Holter monitoring. Which client statement indicates that the teaching was successful?A. I should remain as still as possible while wearing the monitor.I will keep a log of daily activities while I am wearing the monitor.I will avoid physical strain while I am wearing the monitor.I will avoid using caffeine while wearing the monitor.

8241. The nurse is teaching a client who is scheduled for 24-hour Holter monitoring. Which client statement indicates that the teaching was successful?I should remain as still as possible while wearing the monitor.I will keep a log of daily activities while I am wearing the monitor.I will avoid physical strain while I am wearing the monitor.I will avoid using caffeine while wearing the monitor.

B.The client should maintain a daily schedule as close to normal as possible while wearing a Holter monitor, and should continue the usual diet. It is important for the client to record all activities while being monitored, for comparison of the activities with EKG tracings during analysis of the data.8342. What statement would best describe an echocardiogram?Percussive tapping of the chest over the heartNoninvasive ultrasound of the lungsInvasive electroconduction examinationSonographic examination of the heart

8442. What statement would best describe an echocardiogram?Percussive tapping of the chest over the heartNoninvasive ultrasound of the lungsInvasive electroconduction examinationSonographic examination of the heartD. Echocardiogram is a noninvasive ultrasound or sonograph of the heart for visualization purposes.

8543. Following cardiac catheterization, what nursing diagnosis would be the most appropriate?Risk for clot displacementRisk for fluid volume deficitRisk for situational fearRisk for disturbed individual coping

8643. Following cardiac catheterization, what nursing diagnosis would be the most appropriate?Risk for clot displacementRisk for fluid volume deficitRisk for situational fearRisk for disturbed individual copingB. Bleeding at the site of catheter introduction is a potential complication leading to fluid volume deficit. Clot displacement is not a nursing diagnosis8744. Which statement would be appropriate for a pulmonary function test?Residual volume is the maximum amount of air that can be expiredVital capacity is the amount of air left after expirationTidal volume is the amount of air exchangedPulmonary function may be used to diagnose early stage lung cancer8844. Which statement would be appropriate for a pulmonary function test?Residual volume is the maximum amount of air that can be expiredVital capacity is the amount of air left after expirationTidal volume is the amount of air exchangedPulmonary function may be used to diagnose early stage lung cancerC. This is the only correct statement.

8945. A post-bronchoscopy client develops wheezing, stridor, and becomes cyanotic. Identify the highest priority nursing action.Check the gag reflex to make sure the local anesthetic has worn offCall the clients physician about the symptomsAssess breath sounds and maintain the airwayEncourage the client to cough and deep-breathe to reduce secretions

9045. A post-bronchoscopy client develops wheezing, stridor, and becomes cyanotic. Identify the highest priority nursing action.Check the gag reflex to make sure the local anesthetic has worn offCall the clients physician about the symptomsAssess breath sounds and maintain the airwayEncourage the client to cough and deep-breathe to reduce secretions

C. The client is developing respiratory distress from irritation and swelling of the respiratory mucosa. While all four measures may be appropriate nursing actions, at this time assessing and maintaining the airway have the highest priority.

9146. Which instruction is appropriate when providing education to the client who is scheduled for a thoracentesis,?

No eating or drinking will be allowed until your gag reflex returns.A feeling of pressure may be experienced during the procedure.Peripheral pulses will be assessed frequently following the procedure.Bedrest with the head elevated is required for 24 hours after the procedure.

9246. Which instruction is appropriate when providing education to the client who is scheduled for a thoracentesis,?

No eating or drinking will be allowed until your gag reflex returns.A feeling of pressure may be experienced during the procedure.Peripheral pulses will be assessed frequently following the procedure.Bedrest with the head elevated is required for 24 hours after the procedure.

B.A feeling of pressure may occur when the physician inserts the large-bore needle into the pleural space. Choices A, C and D are not accurate.

9347. A client is complaining of discomfort 1-2 hours after eating with feelings of fullness. How might this best be assessed?JejunoscopyLaparoscopyGastroscopyLower GI series

9447. A client is complaining of discomfort 1-2 hours after eating with feelings of fullness. How might this best be assessed?JejunoscopyLaparoscopyGastroscopyLower GI seriesC. Gastroscopy is the direct visualization of the stomach. Another possible assessment would be an upper GI series.

9548. The nurse is preparing a client for a colonoscopy scheduled for the next morning. Select the physician order that would require clarification.

Administration of a cleansing enemaClear liquid diet the day before the procedureObtaining a client signature on a consent formA regular breakfast ordered before the procedure

9648. The nurse is preparing a client for a colonoscopy scheduled for the next morning. Select the physician order that would require clarification.

Administration of a cleansing enemaClear liquid diet the day before the procedureObtaining a client signature on a consent formA regular breakfast ordered before the procedure

D.The other choices are appropriate orders prior to a colonoscopy. Since the intestinal system is the focus of this diagnostic procedure, it doesnt make sense for the client to have regular food prior to the procedure.

9749. What would be the best client position for a sigmoidoscopy?Left lateral SimsRight lateral SimsKnee-chestTrendelenburg9849. What would be the best client position for a sigmoidoscopy?Left lateral SimsRight lateral SimsKnee-chestTrendelenburgC. This is the correct position.

9950. After paracentesis, all of the assessment data is identified. On which should the RN focus the care first?Hypotension and flushed skinEupnea and increased bowel soundsPeripheral edema and thirstNausea and fatigue

10050. After paracentesis, all of the assessment data is identified. On which should the RN focus the care first?Hypotension and flushed skinEupnea and increased bowel soundsPeripheral edema and thirstNausea and fatigue

A. These are symptoms of hypovolemia with vasodilatation and shock and need immediate attention. While the other symptoms will require attention, they do not place the client in immediate danger.

10151. Which statement by the certified nursing assistant indicates understanding of the correct procedure for obtaining a stool specimen for culture and sensitivity?

Apply a thin smear of the stool specimen to a guaiac-impregnated card.A special preservative must be placed in the container with the specimen.I need to give a small enema to evacuate stool from the bowel for collection.A sterile container must be used for specimen collection.

10251. Which statement by the certified nursing assistant indicates understanding of the correct procedure for obtaining a stool specimen for culture and sensitivity?

A. Apply a thin smear of the stool specimen to a guaiac-impregnated card.B.A special preservative must be placed in the container with the specimen.C.I need to give a small enema to evacuate stool from the bowel for collection.D.A sterile container must be used for specimen collection.

D. All specimens for culture and sensitivity must be placed in sterile containers to eliminate the possibility of contamination by outside organisms.10352. Which client statement about conscious sedation (moderate sedation) for a colonoscopy indicates that teaching by the nurse has been effective?

After I receive the medicine, Ill be out like a light and will sleep soundly through the whole procedure.The medicine Ill be given for this type of sedation is Stadol (butorphanol), the same medicine I took for pain after my hernia operation.I will need to be hospitalized the night before the colonoscopy to be observed for any side effects to a test dose of the conscious sedation medicine.This kind of sedation will help me relax, so I can cooperate with the doctor during the colonoscopy.

10452. Which client statement about conscious sedation (moderate sedation) for a colonoscopy indicates that teaching by the nurse has been effective?

After I receive the medicine, Ill be out like a light and will sleep soundly through the whole procedure.The medicine Ill be given for this type of sedation is Stadol (butorphanol), the same medicine I took for pain after my hernia operation.I will need to be hospitalized the night before the colonoscopy to be observed for any side effects to a test dose of the conscious sedation medicine.This kind of sedation will help me relax, so I can cooperate with the doctor during the colonoscopy.

D.Conscious sedation or twilight sleep facilitates decrease in anxiety and promotes cooperation and relaxation. The protective airway reflexes are maintained. Midazolam (Versed) is one agent commonly used for conscious sedation.

105