Question 1

A client is scheduled for an intravenous pylogram (IVP). After the contrast material is injected, which of the following client reactions should be reported immediately?

Accepted Answer

Answer reason: Hives indicate an allergic reaction/anaphylaxis to iodinated contrast and must be reported immediately. Warmth, flushing, and a salty taste are expected transient effects after IVP contrast injection.

Question 2

A confused client is ordered arterial blood gases. The respiratory therapist draws the blood and then asks the nurse to apply pressure to the area so the therapist can take the specimen to the lab. How long should the nurse apply pressure to the area?

Accepted Answer

Answer reason: After an arterial puncture for ABGs, firm pressure is held for about 5 minutes to prevent bleeding and hematoma; longer may be needed if on anticoagulants.

Question 3

An 80 year-old client is admitted with a diagnosis of malnutrition. In addition to physical assessments, which of the following lab tests should be closely monitored?

Accepted Answer

Answer reason: Serum albumin reflects visceral protein stores and is a key marker of protein-calorie malnutrition; urine protein/creatinine assess renal function, and serum calcium is not a sensitive indicator of nutritional status.

Question 4

A client newly diagnosed with Type I Diabetes Mellitus asks the purpose of the test measuring glycosylated hemoglobin. The nurse should explain that the purpose of this test is to determine?

Accepted Answer

Answer reason: HbA1c reflects the proportion of hemoglobin glycosylated over the RBC lifespan (~120 days), providing the average blood glucose over the previous 2–3 months.

Question 5

Which of the following should the nurse implement to prepare a client for a KUB (Kidney, Ureter, Bladder) radiograph test?

Accepted Answer

Answer reason: A plain KUB radiograph requires no special preparation; patients do not need to be NPO, receive enemas, or be premedicated.

Question 6

What is the most specific method to assess treatment in an AIDS client?

Accepted Answer

Answer reason: Treatment response in HIV/AIDS is monitored by immune status, primarily the CD4 T-cell count. Western blot is for diagnosis confirmation, CD8 count is less useful for monitoring, and Vidal/Widal test is unrelated.

Question 7

What is the specific method used for treatment assessment in clients with AIDS?

Accepted Answer

Answer reason: CD4 count monitors immune status and response to antiretroviral therapy in HIV/AIDS. Western blot is for diagnostic confirmation, CD8 count is not the primary marker for treatment monitoring, and Vidal/Widal test is for typhoid fever.

Question 8

A 21-year-old woman at 16-weeks gestation undergoes an amniocentesis. The client asks the nurse what the physician will learn from this procedure. The nurse’s response should be based on an understanding that which of the following conditions can be detected by this test?

Accepted Answer

Answer reason: Amniocentesis analyzes amniotic fluid for bilirubin and other markers, allowing detection of fetal hemolysis in Rh isoimmunization (hemolytic disease). The other options are structural anomalies typically identified by ultrasound, not by amniotic fluid analysis.

Question 9

A 34-year-old man comes to the clinic for the results of a glycosylated hemoglobin assay (HbA1c). Which statement, if made by the client to the nurse, indicates an understanding of this procedure?

Accepted Answer

Answer reason: HbA1c reflects average glycemic control over the previous 6–8 weeks; it does not require fasting, special diet, or a fingerstick screening method.

Question 10

When obtaining a specimen from a client for sputum culture and sensitivity (C and S), the nurse knows that which of the following instructions is BEST?

Accepted Answer

Answer reason: Early-morning deep cough yields the most concentrated lower-airway sputum and reduces saliva contamination, which is optimal for culture and sensitivity. Saving sputum for days is incorrect, pursed-lip breathing is unrelated, and collecting after a treatment is not standard for C&S.

Question 11

The nurse is preparing a client for a magnetic resonance imaging (MRI). Which of the following client statements indicates to the nurse that teaching has been successful?

Accepted Answer

Answer reason: MRI is a noninvasive, generally painless scan that commonly lasts 45–90 minutes. Routine anesthesia is not required, contrast does not turn urine green, and talk of wires on the head/chest reflects confusion with other tests.

Question 12

The nurse is teaching a school-aged child and family about the use of inhalers prescribed for asthma. What is the BEST way to evaluate effectiveness of the treatments?

Accepted Answer

Answer reason: Peak-flow measurement provides an objective assessment of airway obstruction and response to inhaled therapy. Self-report is subjective, and skin color or pulse rate are indirect and late indicators.

Question 13

A nurse is monitoring the oxygen saturation level of an infant using pulse oximetry. The nurse should secure the sensor to which of the following areas on the infant?

Accepted Answer

Answer reason: For infants, pulse oximeter probes are best placed on well-perfused sites such as the great toe or foot. The wrist and heel are not recommended sites, and the index finger is typically too small for accurate placement.

Question 14

A client is scheduled for an IVP (Intravenous Pyelogram). Which of the following data from the client's history indicate a potential hazard for this test?

Accepted Answer

Answer reason: IVP uses iodinated contrast. A history of shellfish/iodine allergy increases risk for hypersensitivity to the contrast dye, making it a potential hazard.

Question 15

The nurse is teaching a newly diagnosed asthma client on how to use a peak flow meter. The nurse explains that this should be used to?

Accepted Answer

Answer reason: A peak flow meter measures peak expiratory flow to assess airway obstruction in asthma. It does not measure oxygen saturation, detect environmental allergens, or deliver bronchodilator doses.

Question 16

The nurse is preparing a client with a deep vein thrombosis (DVT) for a Venous Doppler evaluation. Which of the following would be necessary for preparing the client for this test?

Accepted Answer

Answer reason: Venous Doppler ultrasound is a noninvasive test; it does not require fasting, sedation, or discontinuation of anticoagulants.

Question 17

What is the normal range for central venous pressure in mm of H2O?

Accepted Answer

Answer reason: Normal CVP when measured with a water manometer is approximately 2–8 (often cited as 3–8) H2O units, making 2-8 the best match.

Question 18

Which of the following requires arterial blood for analysis?

Accepted Answer

Answer reason: Arterial blood gases (ABG) require arterial sampling, whereas calcium, lipid profile, and liver function tests are typically measured from venous blood.

Question 19

Which test is most commonly used to confirm pregnancy?

Accepted Answer

Answer reason: Urine pregnancy tests detect human chorionic gonadotropin (hCG). They are fast, inexpensive, highly sensitive after the first missed period, and therefore widely used as the initial diagnostic tool.

Question 20

A 12-year-old boy with chronic hepatitis shows emotional lability. The eye exam reveals a golden-brown ring at the corneal margin. What is the next test?

Accepted Answer

Answer reason: A Kayser–Fleischer ring strongly suggests Wilson disease. The next step is measuring serum ceruloplasmin, which is typically low in this condition.

Question 21

Which investigation is the most accurate for confirming appendicitis?

Accepted Answer

Answer reason: A CT scan of the abdomen and pelvis provides the highest diagnostic accuracy for appendicitis, offering excellent visualization of the appendix, surrounding fat stranding, wall thickening, and periappendiceal inflammation. It is significantly more sensitive and specific than ultrasound, especially in adults.

Question 22

Which diagnostic test is considered the gold standard for confirming ischemic stroke?

Accepted Answer

Answer reason: A non-contrast CT scan is used initially in suspected stroke to rapidly differentiate ischemic from hemorrhagic causes. It is the standard first-line test because of its speed, availability, and ability to guide immediate treatment decisions such as thrombolytic therapy.

Question 23

Which investigation is appropriate after identifying a Kayser–Fleischer ring in a child?

Accepted Answer

Answer reason: A KF ring indicates Wilson disease; serum ceruloplasmin is the appropriate initial confirmatory laboratory test before further imaging.

Question 24

Which diagnostic test is MOST appropriate to confirm osteoporosis?

Accepted Answer

Answer reason: A dual-energy X-ray absorptiometry (DEXA) scan directly measures bone mineral density and is the gold-standard test for diagnosing osteoporosis.

Question 25

Which diagnostic test is the initial imaging study of choice in suspected acute stroke to rapidly differentiate ischemic from hemorrhagic causes?

Accepted Answer

Answer reason: A non-contrast CT scan of the brain is the initial imaging study of choice in suspected acute stroke because it is fast, widely available, and effective at differentiating ischemic from hemorrhagic stroke. This distinction is crucial to guide immediate treatment decisions such as thrombolytic therapy.

Question 26

Sputum test is done for?

Accepted Answer

Answer reason: A sputum test examines respiratory secretions for infectious organisms, most notably Mycobacterium tuberculosis, using AFB smear, culture, or nucleic acid testing. It is a standard diagnostic test when pulmonary tuberculosis is suspected. Diabetes and kidney stones are not evaluated with sputum, and cancer diagnosis generally requires tissue biopsy or cytology from the affected site.

Question 27

The nurse is sending cerebral spinal fluid (CSF) to the lab. The nurse knows the test results are normal if which element is negative?

Accepted Answer

Answer reason: Normal CSF is clear and colorless with no red blood cells present. The presence of RBCs indicates bleeding or a traumatic tap. Protein and glucose are normally present within defined ranges, and a few WBCs (0–5) may be seen. Therefore, RBCs should be negative in normal CSF.

Question 28

The results of which diagnotic test that confirm the diagnosis of TB?

Accepted Answer

Answer reason: Microbiologic confirmation of tuberculosis is established by culture of Mycobacterium tuberculosis from sputum or another specimen, which is considered the diagnostic gold standard and allows drug-susceptibility testing. The tuberculin skin test only indicates prior exposure or infection and cannot confirm active disease. Bronchoscopy is a procedure to obtain samples but does not itself confirm TB. A saline test is not used to diagnose TB.

Question 29

Which investigation confirms missed abortion?

Accepted Answer

Answer reason: Missed abortion is intrauterine fetal death without expulsion. Transvaginal ultrasound confirms the diagnosis by demonstrating absence of fetal cardiac activity and/or an empty gestational sac with specific size criteria. X-ray is not used in pregnancy for this purpose, and blood sugar or routine urine tests do not diagnose fetal demise.

Question 30

During ABG analysis blood is collected from?

Accepted Answer

Answer reason: Arterial blood gases require an arterial sample, most commonly from the radial artery after confirming collateral flow (Allen test). Arterial blood reflects systemic oxygenation and ventilation status for accurate PaO2, PaCO2, and pH values. Venous samples provide venous blood gases and differ significantly, and capillary samples are only rough substitutes in specific pediatric settings. Therefore, the correct source is an artery.

Question 31

Which position is used for ECG recording?

Accepted Answer

Answer reason: Standard 12‑lead ECGs are obtained with the patient lying supine, relaxed, and still to minimize skeletal muscle artifact. This position allows accurate and reproducible placement of limb and precordial electrodes on the chest. Although slight head elevation may be used for comfort in dyspnea, the reference position for recording is supine.

Question 32

Retained bits of placenta can be detected by?

Accepted Answer

Answer reason: Transvaginal or transabdominal ultrasound is the first-line imaging modality for suspected retained products of conception. It can identify echogenic intrauterine material and assess vascularity with Doppler, aiding diagnosis and management decisions. Plain X-ray is poor for soft tissue detection, and CT or MRI are not routinely used for this indication due to cost, radiation (CT), and limited added value. Therefore, ultrasound is preferred.

Question 33

Which of the following would be affected by allowing a urine specimen to remain at room temperature for three hours before analysis?

Accepted Answer

Answer reason: When urine stands at room temperature, bacterial growth metabolizes urea to ammonia and CO2 diffuses out, causing the urine to become more alkaline and raising the pH. Protein and occult blood results are relatively stable over a few hours, and while cells may lyse, the blood reagent pad still detects hemoglobin peroxidase activity. Specific gravity is minimally affected in a closed container over a short period. Thus, pH is the parameter most affected by prolonged standing.

Question 34

Normal SpO2 value in healthy adults is?

Accepted Answer

Answer reason: In healthy adults, pulse oximetry typically reads 95–100%, reflecting adequate arterial oxygen saturation. Levels below about 90% indicate hypoxemia and warrant assessment/intervention. While some chronic lung disease patients may have lower acceptable baselines, the question specifies healthy adults, making 95–100% the correct normal range.

Question 35

The Mantoux test is performed for?

Accepted Answer

Answer reason: The Mantoux test is the tuberculin skin test that screens for infection with Mycobacterium tuberculosis. Purified protein derivative (PPD) is injected intradermally and the induration is measured at 48–72 hours to detect a delayed-type hypersensitivity reaction. It is not used to diagnose malaria or specific liver or kidney diseases.

Question 36

A nurse is working with a patient who is being tested for diabetes. The physician has ordered a hemoglobin A1C test and the nurse checks the results. The patient asks, 'What is the hemoglobin A1C test?' Which response from the nurse is correct?

Accepted Answer

Answer reason: Hemoglobin A1C reflects the percentage of hemoglobin that is glycated, which correlates with the average blood glucose over the lifespan of red blood cells (about 8–12 weeks). It does not measure circulating insulin or insulin response. The 2-hour glucose after a sugary drink describes an oral glucose tolerance test, not HbA1c. Therefore, the correct explanation is that HbA1c indicates how much sugar coats hemoglobin and estimates average glucose over the past two to three months.

Question 37

According to the nurse, which kind of diagnostic test is most likely to assist in identifying a fractured clavicle?

Accepted Answer

Answer reason: Suspected clavicle fractures are most commonly identified with plain radiographs (X-rays), which use electromagnetic radiation. X-rays are rapid, widely available, and provide clear visualization of bony alignment and fracture lines. CT may be used for complex or occult fractures, and MRI is better for soft-tissue evaluation; ultrasound is not the standard first-line test for clavicle fractures.

Question 38

In the correct order of draw, which of the following tubes should be drawn first?

Accepted Answer

Answer reason: The correct venipuncture order of draw after blood cultures is light blue (sodium citrate) to minimize additive carryover that could alter coagulation results. Citrate tubes must be collected early to preserve accurate PT/INR and aPTT testing by avoiding contamination from anticoagulants like heparin or EDTA. Green (heparin), lavender (EDTA), and gray (fluoride/oxalate) are drawn later because their additives can interfere with coagulation assays if carried over into the citrate tube.

Question 39

Which test confirms HIV infection after a positive screening test?

Accepted Answer

Answer reason: After an initial positive HIV screening test (historically ELISA/rapid antibody), a confirmatory assay is needed to verify HIV-specific antibodies and reduce false positives. Western blot has been classically used as the confirmatory test because it detects antibodies to multiple distinct HIV proteins. Blood culture, urinalysis, and CT scan do not confirm HIV infection. (Note: many current algorithms use an HIV-1/2 differentiation immunoassay and/or nucleic acid testing, but among the listed options Western blot is the correct confirmatory test.).

Question 40

A nurse is reinforcing teaching with a client who has urinary retention and is scheduled for a bladder scan. Which of the following instructions should the nurse include?

Accepted Answer

Answer reason: A bladder scan is a noninvasive ultrasound assessment of bladder volume performed by placing ultrasound gel on the lower abdomen just above the symphysis pubis and applying the probe over that area. The procedure does not require informed consent because it is noninvasive and low risk. The client does not need to hold urine for an hour beforehand when the purpose is to evaluate urinary retention, and no IV/oral contrast dye is used for a bedside bladder scan.

Question 41

A pregnant client is having a nonstress test (NST). It is noted that the fetal heart beat rises 20 bpm, lasting 20 seconds, every time the fetus moves. The nurse explains that?

Accepted Answer

Answer reason: A reactive NST is defined by fetal heart rate accelerations with fetal movement, indicating intact fetal oxygenation and neurologic responsiveness. An acceleration of at least 15 bpm lasting at least 15 seconds (after 32 weeks) is considered reassuring; this stem describes 20 bpm for 20 seconds with movement, which meets reactive criteria. Therefore the NST is normal and does not indicate fetal distress or the need for additional testing based solely on this finding.

Question 42

A male client suspected of having colorectal cancer will require which diagnostic study to confirm the diagnosis?

Accepted Answer

Answer reason: Confirmation of colorectal cancer requires direct visualization of the colon/rectum with the ability to obtain a biopsy; endoscopic evaluation (e.g., sigmoidoscopy/colonoscopy) provides histologic diagnosis. Stool Hematest can detect occult blood but is only a screening test and is not diagnostic for cancer. CEA is a tumor marker mainly used for monitoring treatment response/recurrence rather than establishing an initial diagnosis. CT scanning is useful for staging and detecting metastases, but it does not confirm cancer without tissue diagnosis.

Question 43

A client is scheduled for a magnetic resonance imaging (MRI) scan. Nurse Davis must prioritize assessing the client for which contraindication before the procedure?

Accepted Answer

Answer reason: Before MRI, the nurse should prioritize screening for pregnancy because fetal safety is a key concern and gadolinium contrast (if needed) is generally avoided in pregnancy unless absolutely necessary. While MRI without contrast is often considered acceptable, pregnancy status can change the risk-benefit assessment and procedural planning. A titanium hip prosthesis is typically MRI-compatible and not an absolute contraindication. Antibiotic allergies and inability to move the feet are not MRI contraindications; neurologic deficits may be relevant clinically but do not preclude MRI.

Question 44

A client is scheduled for a myelogram. What position should the patient assume during contrast dye injection?

Accepted Answer

Answer reason: During a myelogram, contrast is typically injected into the subarachnoid space via lumbar puncture. The side-lying curled-up (fetal) position flexes the spine, widens the intervertebral spaces, and helps the provider access the lumbar cistern more safely and effectively. This position also helps the patient maintain stillness during needle insertion and contrast injection, reducing the risk of traumatic tap or inadequate placement. The other positions do not optimally flex the lumbar spine for intrathecal access.

Question 45

A newborn screening test comes back positive for hypothyroidism. What is the priority nursing action?

Accepted Answer

Answer reason: A positive newborn screen is a preliminary result that requires urgent confirmatory serum testing (e.g., TSH/free T4) and prompt initiation of levothyroxine if confirmed to prevent irreversible neurodevelopmental impairment. Waiting 6 weeks delays diagnosis and treatment during a critical window for brain development. Breastfeeding should not be stopped for suspected congenital hypothyroidism, and iron supplementation is not indicated and can interfere with levothyroxine absorption if given together. Therefore, the priority is immediate referral for confirmatory testing and timely treatment.

Question 46

Tonometry is performed on the client with a suspected diagnosis of glaucoma. The nurse analyzes the test results as documented in the client’s chart and understands that?

Accepted Answer

Answer reason: Tonometry measures intraocular pressure (IOP). Normal IOP is approximately 10–21 mmHg; values above this range are considered elevated and are consistent with glaucoma risk. A reading in the 22–30 mmHg range therefore supports suspicion of glaucoma. The other ranges are either normal (10–21) or implausibly low/high for the typical testing context presented.

Question 47

A patient is suspected of having a pulmonary embolism. Which laboratory test would the nurse anticipate being ordered?

Accepted Answer

Answer reason: In suspected pulmonary embolism, a D-dimer is commonly ordered because it detects fibrin degradation products and is sensitive for thrombus formation. A normal (negative) D-dimer can help rule out PE in patients with low to intermediate pretest probability, reducing the need for imaging. Troponin and BNP may be elevated in PE due to right ventricular strain but they are not primary diagnostic screening tests. Hemoglobin A1c evaluates long-term glycemic control and is unrelated to PE diagnosis.

Question 48

A patient is scheduled for a spinal tap (lumbar puncture). Which position is best during the procedure?

Accepted Answer

Answer reason: This position maximizes flexion of the lumbar spine, widening the intervertebral spaces to facilitate needle insertion and improve procedural success. It also helps the patient maintain a stable, curved-back posture, which reduces the risk of traumatic tap and patient movement during the procedure. In contrast, supine or prone positions do not optimize lumbar flexion, and the lateral position is typically preferred with knees flexed (fetal position), not with legs extended.

Question 49

A 68-year-old male with a history of hypertension and diabetes presents to the emergency department with sudden onset of dyspnea and pleuritic chest pain. His initial examination reveals elevated heart rate and decreased oxygen saturation. Recent lab results show a decreased Glomerular Filtration Rate (GFR) of 40 mL/min. Given the suspicion of pulmonary embolism (PE), which investigation would be the most appropriate first step for this patient?

Accepted Answer

Answer reason: In suspected PE, CT pulmonary angiography is often preferred, but it requires iodinated contrast that can worsen kidney function. With a reduced GFR (40 mL/min), a V/Q scan is a safer initial diagnostic test because it avoids nephrotoxic contrast exposure. Pulmonary angiography is invasive and typically reserved when noninvasive testing is inconclusive. A chest x ray is commonly obtained in dyspnea workups but is not sufficiently sensitive or specific to diagnose PE and would not be the best first diagnostic test to confirm PE in this context.

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