Question 1

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

Accepted Answer

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

Question 2

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

Accepted Answer

A patient needs to be NPO for 6 to 8 hours before the procedure to prevent possible aspiration because 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 3

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

Accepted Answer

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

Question 4

Which is the appropriate patient position for a lumbar puncture?

Accepted Answer

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

Question 5

What action should the nurse take after an angiography?

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 procedure.Emphasize the need to lie flat for 6 to 12 hours.

Question 6

The nurse is caring for a patient who has just undergone a bronchoscopy and has been in recovery for the last 15 minutes.The nurse should be especially watchful for which of the following? (Select all that apply.)

Accepted Answer

Laryngospasm and bronchospasm evidenced by sudden,severe shortness of breath is an unexpected and potentially lethal outcome.Call health care provider or physician immediately,prepare emergency resuscitation equipment,and anticipate possible cricothyrotomy.Observe respiratory status closely,particularly for facial or neck crepitus.Detects an early sign of bronchial perforation.Gag reflex does not normally return until 2 hours after the procedure.

Question 7

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

Accepted Answer

In elective lumbar puncture (LP),preprocedure 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 CSF for visualization and laboratory examination; and to inject anesthetic,diagnostic,or therapeutic agents.CT will not do these.

Question 8

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

Accepted Answer

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

Question 9

Both aspiration and biopsy diagnose and differentiate which of the following: leukemia,certain malignancies,anemia,and thrombocytopenia? (Select all that apply.)

Accepted Answer

Both aspiration and biopsy diagnose and differentiate leukemia,certain malignancies,anemia,and thrombocytopenia.Heart disease is not diagnosed with these studies.

Question 10

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.)

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 is essential.During and after the procedure,patients need continuous monitoring of vital signs,oxygen saturation,heart rhythm,lung sounds,and level of consciousness.

Question 11

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

Accepted Answer

After procedure: monitor airway patency,vital signs,SpO₂,pain score,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 only a Ramsay sedation score higher than 3 to the physician.

Question 12

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

Accepted Answer

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

Question 13

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?

Accepted Answer

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

Question 14

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

Accepted Answer

Assess patient for possible delayed reaction to iodine dye - dyspnea,hives,tachycardia,and rash.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.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 of reaction to the dye.

Question 15

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

Accepted Answer

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

Question 16

The patient is a 56-year-old man who has terminal cirrhosis and severe ascites.He is lethargic,but 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 has left to prepare for the procedure,the wife asks the nurse if the procedure is really necessary.How should the nurse respond?

Accepted Answer

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

Question 17

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.)

Accepted Answer

If hematoma or hemorrhage is present at catheter insertion site,apply pressure over insertion site,and notify health care provider or physician if interventions do not stop the bleeding of if patient demonstrates symptoms of acute blood loss (hypotension,tachycardia).If the patient has 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/hour is a sign of renal toxicity.Low back pain radiating to both sides of the body is a hallmark sign of retroperitoneal bleeding.

Question 18

For an upper gastrointestinal endoscopy,a nurse should:

Accepted Answer

Remove patient's dentures and other dental appliances to prevent dislodgement of dental structures during intubation phase.Position tip of cannula for easy access in the patient's mouth 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 19

During an electrocardiogram,the patient should anticipate that:

Accepted Answer

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

Question 20

Under which circumstances should a nurse contact the physician to postpone intravenous moderate sedation?

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 patient loss of airway protection,an empty stomach reduces the risk of 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.

Quiz 44: Diagnostic Procedures