Diagnostic Tests Practice Test 9
Diagnostic Tests NCLEX Practice Test
Diagnostic Tests is a key topic within the NCLEX test plan, located under Physiological Integrity → Reduction of Risk Potential → Diagnostic Tests. This section prepares patients, explains procedures, and interprets findings for safe follow-up care. Each test contains 50 questions designed to mirror the difficulty and variety of the real exam.
This is the 9th part of the Diagnostic Tests series. To explore all practice tests under this topic, use the “Back to Main Topic” button at the end of the page.
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Diagnostic Tests Practice Test 9
The nurse in primary health clinic is caring for a 68-year-old man. History reveals that the client has smoked one pack of cigarette per day for 45 years and drinks two beers per day. He is complaining of a non-productive cough, chest discomfort, and dyspnea. The nurse hears isolated wheezing in the right middle lobe. It would be most important for the nurse to do which of the following?
- CPK-MB
- Echocardiogram
- Chest X-ray
- Guthrie
Explanation: Answer reason: g., lung cancer) or other localized pulmonary pathology, which should be evaluated first with an initial chest imaging study. A chest radiograph is the standard first-line diagnostic test to assess for masses, atelectasis, pneumonia, or other structural changes and guides urgent referral for further imaging (e.g., CT) if abnormal. Cardiac tests like CPK-MB or echocardiogram do not directly address a localized unilateral wheeze pattern and respiratory symptoms without a clear cardiac presentation. New or changing respiratory symptoms in a high-risk smoker warrant prompt pulmonary evaluation to reduce risk of delayed diagnosis.
The nurse teaches a client scheduled for an I.V. pyelogram what to expect when the dye is injected. The nurse knows that the client has correctly understood what was taught when he states that he may experience which of the following sensations when the dye is injected?
- A metallic taste.
- Flushing of the face.
- Cold chills.
- Chest pain.
Explanation: Answer reason: Iodinated contrast used in an IV pyelogram commonly causes a brief sensation of warmth and flushing shortly after injection due to vasodilation and the hyperosmolar effect of the dye. This is an expected, transient response that patients should be taught to anticipate so it is not mistaken for an emergency. In contrast, chest pain is not an expected benign sensation and could signal a serious adverse reaction or cardiopulmonary problem requiring immediate evaluation. Cold chills are less characteristic of routine contrast injection teaching than warmth/flushing.
To evaluate a patient for hypoxia, the physician is most likely to order which laboratory test?
- Red blood cell count.
- Sputum culture.
- Total hemoglobin.
- Arterial blood gas (ABG) analysis.
Explanation: Answer reason: Hypoxia is best evaluated by directly measuring arterial oxygenation and ventilation status. An ABG provides PaO2 and SaO2 (oxygenation) along with PaCO2 and pH, allowing confirmation of hypoxemia and associated acid–base/ventilatory abnormalities. Red blood cell count and total hemoglobin assess oxygen-carrying capacity but do not indicate whether blood is adequately oxygenated in the lungs. Sputum culture targets infectious etiology rather than immediate oxygenation status.
The physician orders a 24-hour urine collection to aid in the diagnosis of Cushing's syndrome. The nurse is most accurate in telling the client that the urine collection will begin when?
- With the client's next voiding
- After the client's next voiding
- After drinking a pitcher of water
- With the first voiding in the morning
Explanation: Answer reason: Starting collection immediately after the next voiding ensures the bladder has been emptied and all urine produced afterward is captured. This prevents overcounting urine produced before the official start time, which would distort total analyte excretion (e.g., urinary free cortisol). A common error is beginning with the next void saved, which includes urine accumulated before the start time and invalidates timing accuracy. Accurate timing and complete collection are critical for reliable diagnostic interpretation in suspected hypercortisolism.
When scheduling a patient for skin testing for allergies, which information is most important for the allergy clinic nurse to include in patient teaching?
- Avoid taking antihistamines before the skin testing.
- Skin testing may be done with an intradermal injection.
- Swelling and itching may occur at the site of the skin testing.
- Patient will need to wait in the clinic for 20 minutes after the testing.
Explanation: Answer reason: Skin allergy testing relies on an immediate histamine-mediated wheal-and-flare response to identify sensitization. Antihistamines blunt this response and can cause false-negative results, making the test invalid and potentially delaying correct diagnosis and treatment. This is higher priority than describing technique or expected local reactions because it directly affects test accuracy and clinical decision-making. While post-test observation addresses safety for systemic reactions, the key pre-test teaching that prevents an unreliable test is medication avoidance.
A nurse is preparing to collect a 24-hour urine specimen from the client. Which of the following is an inaccurate action in collecting the specimen?
- Discarding the urine specimen at the start time
- Asking the client to void, saving the specimen, and noting the start time
- Placing the specimen on ice or refrigerating it
- Asking the client to void at the end of the collection and adding this specimen to the collection
Explanation: Answer reason: Therefore, the client should void at the start time and that first urine is discarded while the time is documented, ensuring the collection reflects exactly the next 24 hours. Keeping the initial void falsely increases the measured total because it includes urine produced before the timed interval. Refrigeration/ice and including the final void at the end time are appropriate because they preserve analytes and complete the timed period.
An echocardiogram, chest x-ray (CXR), and computed axial tomography (CAT) scan are prescribed for a client who has activity intolerance. In which order should the nurse plan to schedule the procedures to meet the needs of this client safely and effectively?
- CAT scan and CXR in the morning, and echocardiogram on the following morning
- CXR and echocardiogram together in the morning, and CAT scan in the afternoon of the same day
- Echocardiogram in the morning, and CXR and CAT scans together in the afternoon of the same day
- CXR in the morning, echocardiogram in the afternoon, and CAT scan in the morning of the following day
Explanation: Answer reason: A chest x-ray and echocardiogram are generally quick, noninvasive, and well-tolerated, making them appropriate to schedule together earlier when the client has the most energy. A CT study can take longer, may require transport and prolonged positioning, and may involve contrast-related monitoring, so placing it later in the day after the shorter tests reduces cumulative exertion while completing all tests within a safe timeframe. Plans that split testing across multiple days increase repeated transfers and disruption without clear benefit for tolerance or safety.
An ultrasound of the gallbladder is scheduled for the client with a suspected diagnosis of cholecystitis. Which should the nurse explain to the client about this test?
- The test is uncomfortable.
- The test requires that the client be NPO.
- The test requires the client to lie still for short intervals.
- The test is preceded by the administration of oral tablets.
Explanation: Answer reason: Fasting is required before gallbladder ultrasound because food intake triggers cholecystokinin-mediated gallbladder contraction, which can empty the gallbladder and obscure stones or wall findings. An adequately distended gallbladder improves visualization of the lumen, wall thickening, pericholecystic fluid, and sonographic Murphy sign used to evaluate cholecystitis. The procedure is noninvasive and typically not painful, so describing it as uncomfortable is misleading. No oral contrast tablets are routinely given for a gallbladder ultrasound; that type of preparation is associated with other biliary imaging studies.
The nurse has taught a client who is scheduled for a colonoscopy. Which of the following statements by the client would require follow up?
- I will not be able to eat or drink anything for 24 hours before the procedure.
- I may experience abdominal cramping after the procedure.
- I will be sedated during the procedure.
- I will be placed in the knee-chest position for the procedure.
Explanation: Answer reason: Colonoscopy preparation typically includes clear liquids the day before and nothing by mouth for a shorter interval before sedation (often 6–8 hours for solids, ~2 hours for clear liquids per anesthesia policy), not a full 24 hours of no intake. Over-restricting intake can worsen dehydration and electrolyte imbalance, especially when combined with bowel prep. The other statements reflect expected teaching: mild cramping/bloating can occur from insufflated air, moderate sedation is commonly used, and positioning is usually left lateral (often with knees flexed) rather than requiring the client to be fully NPO for 24 hours. This statement signals misunderstanding of pre-procedure instructions and should be clarified for safety.
A child presents to the emergency following ingestion of around 20 mL of kerosene oil about 40 minutes back. The child appears stable. Which one of the following measures should be done for the management of the child?
- Gastric lavage
- Oxygen therapy
- Intravenous steroids
- Radiography
Explanation: Answer reason: In a stable child, the key management is observation and assessment for evolving respiratory involvement rather than attempting gastric lavage. A chest radiograph is recommended to detect early pneumonitis (which may be present even with minimal initial symptoms) and to guide ongoing monitoring. Oxygen is supportive only if respiratory symptoms or hypoxemia develop, and steroids have no proven routine benefit in hydrocarbon pneumonitis.
A 60-year-old comes into the emergency department with crushing substernal chest pain that radiates to the shoulder and left arm. The admitting diagnosis is acute myocardial infarction (MI). Admission prescriptions include oxygen by nasal cannula at 4 L/min, complete blood count (CBC), a chest radiograph, a 12-lead electrocardiogram (ECG), and 2 mg of morphine sulfate given IV. The nurse should first?
- Administer the morphine.
- Obtain a 12-lead ECG.
- Obtain the blood work.
- Prescribe the chest radiograph.
Explanation: Answer reason: Time-sensitive diagnosis and reperfusion decisions in suspected MI depend on immediate ECG acquisition to identify STEMI and guide urgent therapies (e.g., cath lab activation). This test should be prioritized before noncritical labs and imaging because delays directly worsen myocardial salvage and outcomes. Analgesia with morphine can be helpful for pain/anxiety but can also mask symptoms and should not precede obtaining the key diagnostic data needed for definitive management. A chest radiograph and CBC are adjuncts for differential/complication assessment and do not drive the initial MI pathway as rapidly as the ECG.
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