Question 1

Under which circumstances should a nurse contact the physician to postpone an angiography?
A)If a patient has been nothing by mouth (NPO)for only 1 hour.
B)If a patient's femoral site has been shaved and cleansed with an antiseptic.
C)If the patient received Benadryl as a preprocedure medication.
D)When test results reveal a blood urea nitrogen (BUN)level of 15 mg/100 mL and a creatinine level of 0.8 mg/mL.

Accepted Answer

A patient needs to be NPO for 6 to 8 hours before the procedure to prevent possible aspiration because the patient is sedated.The site of catheter insertion needs to be shaved and prepped with antiseptic just before the procedure.Benadryl is used prophylactically to block histamine and decrease allergic responses.Elevated BUN or creatinine levels would place patients at risk for renal failure induced by contrast media.

Question 2

A nurse should contact the physician to postpone intravenous moderate sedation if the patient:
A)has been nothing by mouth (NPO)for 1 hour.
B)has a history of substance abuse.
C)has no history of latex allergy.
D)has demonstrated an understanding of the procedure.

Accepted Answer

Verify that the patient has not ingested food or fluids,except for oral medications,for at least 4 hours.Verify specific agency requirements.Because a risk of moderate sedation is loss of airway protection,an empty stomach reduces the risk for aspiration.A history of substance abuse is not a contraindication to the procedure,although it usually requires dose adjustment of the sedative.With no history of latex allergy,allergic reactions are not a concern.An understanding of the procedure implies that consent was informed.

Question 3

The nurse is caring for a patient who has received moderate sedation for a procedure at the bedside.Which task can be delegated to the nursing assistive personnel (NAP)during this procedure?
A)Assessing sedation score
B)Obtaining blood pressure
C)Monitoring respiratory rate
D)Recording urine output

Accepted Answer

The task of assisting with intravenous (IV)moderate sedation,including the pre-procedure assessment,cannot be delegated to nursing assistive personnel (NAP).In most agencies,an RN or health care provider assesses and monitors a patient's level of sedation,airway patency,and level of consciousness.Roles in monitoring depend on scope-of-practice guidelines as determined by state regulations (see agency policy).You could delegate to assistive personnel the task of recording urine output.

Question 4

What action should the nurse take after an angiography?
A)Limit the patient's fluid intake.
B)Have the patient ambulate as soon as possible.
C)Apply a pressure dressing to the vascular site.
D)Maintain the patient in a sitting position while he or she is in bed.

Accepted Answer

Five to 15 minutes of manual pressure is often enough to stop active site bleeding.However,a certain amount of bed rest is needed to achieve reliable hemostasis.Check agency policy for postprocedure bed rest requirements.This is often up to 6 hours when no vascular closure device is used.Encourage patient to drink 1 to 2 L of fluid after the procedure.Emphasize the need to lie flat for 6 to 12 hours.

Question 5

The nurse is caring for a patient who underwent a cardiac catheterization.The sheaths have just been removed.You should assess the patient carefully for what potential complication?
A)Vasovagal reaction
B)Hypertension
C)Tachycardia
D)Allergic reaction

Accepted Answer

Before removing the catheter sheath,check the health care provider's orders for instructions on treating a vasovagal reaction.Manual pressure applied to the groin/femoral area can stimulate the baroreceptors and cause a vasovagal reaction in which the patient becomes bradycardic and hypotensive.Vasovagal reactions are usually brief and self-limited.When applying pressure to the groin after sheath removal,be alert for a vasovagal reaction and be prepared to treat it by lowering the head of the bed to the flat position and giving a bolus of intravenous (IV)fluids.

Question 6

When explaining what to expect during a bronchoscopy,the nurse informs the patient that:
A)an anesthetic solution will be swallowed.
B)the tube will be passed through the nose.
C)nothing will be given by mouth for 2 to 3 hours before.
D)no food or fluid will be provided until the gag reflex returns.

Accepted Answer

Do not allow the patient to eat or drink until the tracheobronchial anesthesia has worn off and the gag reflex has returned-usually for 2 hours.Instruct the patient not to swallow the local anesthetic.The bronchoscope is introduced into the mouth,to the pharynx,to pass through the glottis.The patient should have taken nothing by mouth for at least 8 hours before a bronchoscopy.

Question 7

Which action should the nurse take after a procedure requiring intravenous moderate sedation?
A)Report to the physician a Ramsay sedation score that is less than 3.
B)Monitor airway patency and vital signs every 5 minutes for 30 minutes.
C)Take vital signs every 15 minutes for the next 2 hours.
D)Take vital signs every 30 minutes until stable.

Accepted Answer

After the procedure,monitor airway patency,vital signs,SpO?,pain score,and level of consciousness every 5 minutes for at least 30 minutes,then every 15 minutes for an hour,and then every 30 minutes until the patient meets the discharge criteria on the agency's designated scoring system.Report to the physician only a Ramsay sedation score higher than 3.

Question 8

The patient will be undergoing moderate intravenous (IV)sedation.The nurse needs to assess which of the following during the procedure? (Select all that apply. )
A)Airway compromise
B)Hemodynamic instability
C)Agitation
D)Combativeness

Accepted Answer

Patient risks during IV sedation include hypoventilation,airway compromise,hemodynamic instability,and/or altered levels of consciousness that include an overly depressed level of consciousness or agitation and combativeness.Emergency equipment appropriate for the patient's age and size and staff with skill in airway management,oxygen delivery,and use of resuscitation equipment are essential.During and after the procedure,patients need continuous monitoring of vital signs,oxygen saturation,heart rhythm,lung sounds,and level of consciousness.

Question 9

During an electrocardiogram,the patient should anticipate that:
A)chest pain may occur.
B)the electrode sites will be cleaned with alcohol.
C)talking and moving around will be allowed.
D)the electrodes are attached with ties or rubber straps.

Accepted Answer

Clean and prepare the skin;wipe the sites with alcohol to help remove oils that would prevent adherence of the electrodes.Although the procedure is painless,it is important to document and note whether the patient is experiencing any chest discomfort during the procedure.Instruct the patient to lie still without talking.Electrodes are self-sticking.

Question 10

In which position is the patient usually placed for a thoracentesis?
A)Dorsal recumbent position
B)Supine with the arms over the head
C)Sims' position on the affected side
D)Sitting and leaning over a bedside table

Accepted Answer

Place the patient in the orthopneic position (upright position with arms and shoulders raised and supported on a padded over-bed table).If the patient is unable to tolerate this position,assist the patient to a side-lying position with the affected lung positioned upward.This expands the intercostal space for needle insertions.

Question 11

The patient is a 56-year-old man who has terminal cirrhosis and severe ascites.He is lethargic but is demonstrating signs of discomfort and respiratory distress.The physician has spoken with the patient's wife and has obtained consent to perform an abdominal paracentesis on the patient.After the physician leaves to prepare for the procedure,the wife asks the nurse whether the procedure is really necessary.The nurse should respond by saying this:
A)is the first step in the patient's recovery.
B)may help the patient feel better.
C)is needed to detect increased intracranial pressure.
D)is needed to analyze pleural fluid.

Accepted Answer

The patient is diagnosed as terminal.Paracentesis is a palliative measure used to provide temporary relief of abdominal and respiratory discomfort caused by severe ascites.Intracranial pressure is assessed with computed tomography.Thoracentesis,not paracentesis,is performed to analyze or remove pleural fluid.

Question 12

The nurse is preparing to assist with a bone marrow aspiration on a 3-month-old infant.The nurse may expect that the physician will use which site to perform the aspiration?
A)Sternum
B)Anterior iliac crest
C)Proximal tibia
D)Posterior iliac crest

Accepted Answer

In children,the anterior or posterior iliac crest is used,and in infants,the proximal tibia is used.

Question 13

The patient has undergone a cardiac catheterization.It has been 2 hours since the catheter and sheath have been removed.Which of the following would be a concern for the nurse recovering the patient after the procedure? (Select all that apply. )
A)Swelling and hardness at the catheter insertion site
B)Complaints of itching and urticaria
C)Urine output less than 30 mL/hr
D)Low back pain radiating to both sides of the body

Accepted Answer

If hematoma or hemorrhage is present at the catheter insertion site,apply pressure over the insertion site,and notify the health care provider or physician if interventions do not stop the bleeding,or if the patient demonstrates symptoms of acute blood loss (hypotension,tachycardia).If the patient has an allergic reaction to contrast medium manifested by symptoms of flushing,itching,and urticaria,continue monitoring the patient and assess for anaphylaxis.Notify the health care provider.Renal toxicity from contrast can be detected by monitoring intake and output.Urine output of less than 30 mL/hr is a sign of renal toxicity.Low back pain radiating to both sides of the body is a hallmark sign of retroperitoneal bleeding.

Question 14

The nurse is alert to a possible delayed reaction to the dye injected during an angiography.For which response should she monitor the patient?
A)Pallor
B)Dyspnea
C)Thirst
D)Numbness and tingling

Accepted Answer

Assess the patient for a possible delayed reaction to iodine dye,seen as dyspnea,hives,tachycardia,and rash.This reaction occurs up to 6 hours after injection of dye.Thirst,by itself,is not a major warning sign of reaction to the dye.Pallor,by itself,is not a major warning sign of reaction to the dye.A patient's report of any feelings of pain,dyspnea,numbness or tingling,or other untoward symptoms may indicate cardiac complications or procedure site complications,but not a reaction to the dye.

Question 15

For an upper gastrointestinal endoscopy,a nurse should:
A)remove the patient's dentures.
B)suction the patient every 5 minutes.
C)place the patient in high-Fowler's position.
D)provide fluids immediately after the test is finished.

Accepted Answer

Remove the patient's dentures and other dental appliances to prevent dislodgement of dental structures during the intubation phase.Position the tip of the cannula in the patient's mouth for easy access to drain oral secretions;suction as needed.Help the patient to maintain left lateral Sims' position.Instruct the patient not to eat or drink after the procedure until the gag reflex returns,which is usually about 2 hours after the procedure.

Question 16

The nurse is discussing the patient's upcoming elective lumbar puncture,and explains that the patient will probably need to undergo computed tomography of the brain before the procedure is done.What is the reason for this?
A)Diagnose central nervous system (CNS)infection.
B)Rule out increased intracranial pressure.
C)Visualize cerebrospinal fluid.
D)Measure pressure in the subarachnoid space.

Accepted Answer

In elective lumbar puncture (LP),pre-procedure computed tomography results are reviewed for evidence of brain shift to rule out increased intracranial pressure.The purpose of the LP procedure itself is to measure pressure in the subarachnoid space;obtain cerebrospinal fluid (CSF)for visualization and laboratory examination;and inject anesthetic,diagnostic,or therapeutic agents.A computed tomography (CT)scan will not allow adequate visualization of these structures.

Question 17

When explaining about a lumbar puncture,the nurse informs the patient that during the procedure,he or she will be asked to:
A)remain very still.
B)cough during the fluid aspiration.
C)change position.
D)breathe deeply during the needle insertion.

Accepted Answer

Emphasize the importance of remaining immobile during the procedure to prevent trauma,especially with the lumbar puncture,because sudden movement is a risk for spinal cord nerve root damage.Also,instruct the patient not to cough,sneeze,or breathe deeply during the procedure because these actions increase the risks for needle displacement and damage to other structures.

Question 18

Which is the appropriate patient position for a lumbar puncture?
A)Prone
B)Supine
C)Sims'
D)Lateral recumbent

Accepted Answer

Position the patient in a lateral recumbent (fetal)position with the head and neck flexed.This provides spinal column full curvature.The spinal column is flexed as much as possible to allow maximal space between vertebrae.

Question 19

A patient who is a candidate for an upper gastrointestinal endoscopy has:
A)been NPO for 8 hours.
B)evident respiratory distress.
C)active gastrointestinal bleeding.
D)an esophageal diverticulum.

Accepted Answer

Verify that the patient has been NPO for at least 8 hours.Evident respiratory distress will increase risk,and the procedure may have to be delayed.This test is contraindicated in patients with severe upper gastrointestinal tract bleed,Zenker's diverticulum,or a large aortic aneurysm.

Question 20

The physician needs to visually examine a patient's esophagus,stomach,and duodenum.The nurse anticipates that the physician will order:
A)endoscopic retrograde cholangiopancreatography (ERCP).
B)esophagoscopy.
C)esophagogastroduodenoscopy (EGD).
D)proctoscopy.

Accepted Answer

Esophagogastroduodenoscopy (EGD)permits visualization of the esophagus,stomach,and duodenum in a single examination.Endoscopic retrograde cholangiopancreatography (ERCP)is performed for visualization of the hepatobiliary tree and pancreatic ducts.Esophagoscopy is used to examine the esophagus only.Proctoscopy offers a visual examination of the lower gastrointestinal tract.

Quiz 8: Diagnostic Procedures

Under which circumstances should a nurse contact the physician to postpone an angiography?

A nurse should contact the physician to postpone intravenous moderate sedation if the patient:

The nurse is caring for a patient who has received moderate sedation for a procedure at the bedside.Which task can be delegated to the nursing assistive personnel (NAP) during this procedure?

What action should the nurse take after an angiography?

The nurse is caring for a patient who underwent a cardiac catheterization.The sheaths have just been removed.You should assess the patient carefully for what potential complication?

When explaining what to expect during a bronchoscopy,the nurse informs the patient that:

Which action should the nurse take after a procedure requiring intravenous moderate sedation?

The patient will be undergoing moderate intravenous (IV) sedation.The nurse needs to assess which of the following during the procedure? (Select all that apply. )

During an electrocardiogram,the patient should anticipate that:

In which position is the patient usually placed for a thoracentesis?

The nurse is preparing to assist with a bone marrow aspiration on a 3-month-old infant.The nurse may expect that the physician will use which site to perform the aspiration?

The patient has undergone a cardiac catheterization.It has been 2 hours since the catheter and sheath have been removed.Which of the following would be a concern for the nurse recovering the patient after the procedure? (Select all that apply. )

The nurse is alert to a possible delayed reaction to the dye injected during an angiography.For which response should she monitor the patient?

For an upper gastrointestinal endoscopy,a nurse should:

The nurse is discussing the patient's upcoming elective lumbar puncture,and explains that the patient will probably need to undergo computed tomography of the brain before the procedure is done.What is the reason for this?

When explaining about a lumbar puncture,the nurse informs the patient that during the procedure,he or she will be asked to:

Which is the appropriate patient position for a lumbar puncture?

A patient who is a candidate for an upper gastrointestinal endoscopy has:

The physician needs to visually examine a patient's esophagus,stomach,and duodenum.The nurse anticipates that the physician will order: