Diagnostic Testing and Specimen Testing 1
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Questions and Answers

What should be avoided before an exercise stress test?

  • Heavy physical activity
  • High-fat meals
  • Alcohol consumption
  • Caffeine intake (correct)

    • Which of the following is a critical requirement for an Electroencephalogram (EEG)?

  • The patient's hair should be clean and dry (correct)
  • Electrodes must be placed on the chest
  • The patient must be sedated
  • The test area should be noisy

    • What is the purpose of monitoring vital signs and pedal pulses after a procedure?

  • To check for potential complications (correct)
  • To assess discomfort level
  • To evaluate skin integrity
  • To measure the effectiveness of anesthesia

    • What must a patient do immediately after undergoing a procedure involving insertion?

    <p>Lie flat for 4-8 hours</p> Signup and view all the answers

    Which statement about the placement of electrodes for an EKG is true?

    <p>Placement is crucial for accurate readings</p> Signup and view all the answers

    What is the primary role of nurses in regard to diagnostic testing?

    <p>Educating patients, preparing them for tests, and assisting healthcare providers</p> Signup and view all the answers

    Which statement about informed consent is true?

    <p>Providers must explain risks and implications before obtaining consent</p> Signup and view all the answers

    What must nurses document when obtaining informed consent?

    <p>Patient name, date of birth, medical record number, and collector's initials</p> Signup and view all the answers

    Why is it important for nurses to be aware of a patient's baseline vital signs?

    <p>To identify potential complications during diagnostic procedures</p> Signup and view all the answers

    Which medication should be avoided before conducting diagnostic tests due to its potential interference?

    <p>Digoxin</p> Signup and view all the answers

    What is a common allergic reaction to iodine-based contrast media?

    <p>Skin flushing or hives</p> Signup and view all the answers

    Which of the following patient allergies should nurses specifically evaluate for, given their relation to iodine sensitivity?

    <p>Shellfish or shrimp allergies</p> Signup and view all the answers

    What are the signs of a severe allergic reaction to iodine contrast medium?

    <p>Hypotension, respiratory distress, and shock</p> Signup and view all the answers

    What dietary restrictions must patients adhere to before undergoing a PET scan?

    <p>Avoid alcohol, caffeine, tobacco, sedatives, and tranquilizers</p> Signup and view all the answers

    Which is NOT a requirement prior to performing a biochemistry test?

    <p>Ultrasound is performed to guide the procedure</p> Signup and view all the answers

    What position should patients be in during a thoracentesis?

    <p>Sitting upright and leaning forward</p> Signup and view all the answers

    What should patients do after undergoing a liver biopsy?

    <p>Lie on their right side and monitor for bleeding</p> Signup and view all the answers

    Which of the following statements is true regarding a lumbar puncture?

    <p>The bladder and bowel should be empty before the procedure</p> Signup and view all the answers

    What should be done immediately before conducting a colonoscopy?

    <p>Perform bowel preparation with laxatives</p> Signup and view all the answers

    What is an important instruction for a patient undergoing amniocentesis before 20 weeks of gestation?

    <p>Have a full bladder</p> Signup and view all the answers

    What is a key preparation step for patients before a bronchoscopy?

    <p>The patient may experience sedation and throat numbing</p> Signup and view all the answers

    Which procedure requires patients to monitor for symptoms post-test and report any coughing or hemoptysis?

    <p>Thoracentesis</p> Signup and view all the answers

    What should patients remember to do before an endoscopic exam?

    <p>Remain NPO after midnight</p> Signup and view all the answers

    What happens to patients after a paracentesis?

    <p>Their abdominal girth should be monitored</p> Signup and view all the answers

    What should be avoided for 1-2 weeks after a bone marrow aspiration?

    <p>Heavy lifting and strenuous exercise</p> Signup and view all the answers

    Which aspect is crucial for patients undergoing a cardiac catheterization?

    <p>Ensure NPO status for 4-8 hours</p> Signup and view all the answers

    What is the appropriate action for a patient after receiving a contrast medium during a contrast x-ray?

    <p>Increase fluid intake to help excrete the dye.</p> Signup and view all the answers

    Which statement about barium studies is true?

    <p>A post-barium lavage is performed after the test.</p> Signup and view all the answers

    Which imaging procedure would require a patient to empty their bowels and bladder before the test?

    <p>Myelogram</p> Signup and view all the answers

    What is a common side effect of contrast media during x-ray procedures?

    <p>Metallic taste and warmth.</p> Signup and view all the answers

    How long should a patient remain still during a myelogram?

    <p>For the duration of the dye injection.</p> Signup and view all the answers

    What is the recommended pre-procedure status for a CT scan?

    <p>NPO for at least four hours and no metal objects.</p> Signup and view all the answers

    What procedure uses a contrast medium to assess gallbladder function?

    <p>Cholecystogram</p> Signup and view all the answers

    In which scenario would a patient's consent form not be necessary?

    <p>There is no situation where consent is unnecessary.</p> Signup and view all the answers

    Which elective procedure would not typically require patients to stop taking metformin?

    <p>CT Scan for patients with a favorable health history.</p> Signup and view all the answers

    What is an appropriate post-procedure care for patients undergoing an arteriogram?

    <p>Bed rest for eight hours post-test.</p> Signup and view all the answers

    Which imaging study specifically evaluates the functionality of the urinary tract?

    <p>Intravenous Pyelogram (IVP).</p> Signup and view all the answers

    What is the purpose of documenting last menstrual cycles in women before radiographic procedures?

    <p>To avoid unnecessary x-rays if pregnant.</p> Signup and view all the answers

    Which of the following procedures involves using a lighted scope?

    <p>Colonoscopy.</p> Signup and view all the answers

    What condition makes MRI procedures contraindicated?

    <p>Metal implants.</p> Signup and view all the answers

    What is the primary goal of monitoring patients for two to six hours after anaphylaxis?

    <p>To identify delayed reactions.</p> Signup and view all the answers

    What is an important responsibility of nurses regarding patient consent for diagnostic tests?

    <p>To document all discussions regarding consent in the medical record.</p> Signup and view all the answers

    Which of the following actions should a nurse take prior to conducting a diagnostic test?

    <p>Gather the necessary supplies and verify the provider's order.</p> Signup and view all the answers

    What should a nurse do if a patient expresses uncertainty about a diagnostic test after consent was initially obtained?

    <p>Contact the provider to clarify the procedure and answer the patient's concerns.</p> Signup and view all the answers

    Why is understanding normal test values significant for nurses?

    <p>To recognize deviations from normal that may indicate complications.</p> Signup and view all the answers

    What aspect of documentation is crucial for nurses when completing a consent form?

    <p>Recording the patient's name, date of birth, and other identifying information.</p> Signup and view all the answers

    What is an appropriate action for a nurse when a patient has a history of allergies before a diagnostic test?

    <p>Inform the healthcare provider of the patient's allergy history.</p> Signup and view all the answers

    What should nurses be familiar with when preparing for specific diagnostic tests?

    <p>The facility policies and procedures associated with each test.</p> Signup and view all the answers

    What role do nurses play in ensuring patient safety during diagnostic testing?

    <p>They monitor the patient’s vital signs to detect potential complications.</p> Signup and view all the answers

    What should a nurse do if a patient has not been informed about a procedure's risks before consent?

    <p>Ensure the provider discusses the risks comprehensively with the patient.</p> Signup and view all the answers

    What information is NOT required on a specimen label?

    <p>Procedure type</p> Signup and view all the answers

    Which of the following best describes the nurse's role in specimen collection?

    <p>Following proper collection techniques and labeling</p> Signup and view all the answers

    What is an essential skill for nurses when preparing patients for diagnostic tests?

    <p>Educating patients about the procedure</p> Signup and view all the answers

    What should be done to manage an iodine allergy reaction in a patient?

    <p>Provide oxygen and consider intubation.</p> Signup and view all the answers

    Which factor should nurses monitor to ensure safe diagnostic testing?

    <p>Possible complications after the test</p> Signup and view all the answers

    Which of the following is necessary for a myelogram procedure?

    <p>Preparation of bowel and bladder.</p> Signup and view all the answers

    What type of technique should be used for collecting specimens?

    <p>Aseptic technique</p> Signup and view all the answers

    What is the primary purpose of an arteriogram?

    <p>To visualize blood flow in the body.</p> Signup and view all the answers

    Which of the following illustrates the prerequisite knowledge for nurses concerning diagnostic tests?

    <p>Familiarity with normal values and deviations for each test</p> Signup and view all the answers

    Which of the following would MOST likely be included in a nurse's responsibilities for specimen collection?

    <p>Transporting specimens to the laboratory promptly</p> Signup and view all the answers

    In which scenario should metformin be discontinued before a CT scan?

    <p>If the patient has kidney or liver issues.</p> Signup and view all the answers

    Which of the following preparations is required before a contrast X-ray?

    <p>Assessment for iodine and shellfish allergies.</p> Signup and view all the answers

    What is a common misconception about specimen labeling by nurses?

    <p>Specimens can be labeled post-collection</p> Signup and view all the answers

    Which of the following is NOT a critical part of the nurse's role in diagnostic testing?

    <p>Conducting all laboratory tests independently</p> Signup and view all the answers

    What post-procedure care is required after an endoscopy procedure?

    <p>Observation for signs of internal bleeding.</p> Signup and view all the answers

    What specific instruction should be given for a patient undergoing a colonoscopy?

    <p>Remain NPO after midnight.</p> Signup and view all the answers

    In what way do nurses contribute to the effectiveness of diagnostic testing?

    <p>By ensuring compliance with preparation and collection protocols</p> Signup and view all the answers

    What is a common side effect anticipated during a contrast X-ray?

    <p>Metallic taste and warmth.</p> Signup and view all the answers

    Which imaging procedure requires the patient to drink only clear fluids before the test?

    <p>Bone Scan.</p> Signup and view all the answers

    What is important to check before performing a CT scan?

    <p>Prior contrast reactions.</p> Signup and view all the answers

    What is a critical preparation requirement for a barium swallow study?

    <p>Remain NPO after midnight</p> Signup and view all the answers

    Which procedure specifically requires the patient to be in a left side lying position during preparation?

    <p>Amniocentesis</p> Signup and view all the answers

    Which post-test monitoring requirement is associated with a lumbar puncture?

    <p>Check for numbness or tingling in lower extremities</p> Signup and view all the answers

    What is an essential action to take before conducting a thoracentesis?

    <p>Obtaining a consent form</p> Signup and view all the answers

    Which imaging study does NOT require patients to avoid eating or drinking prior to the test?

    <p>EKG</p> Signup and view all the answers

    In which scenario would you need to prepare for potential sedation during an endoscopic examination?

    <p>Bronchoscopy</p> Signup and view all the answers

    What post-test care must be followed after a colonoscopy?

    <p>Monitor for signs of rectal bleeding</p> Signup and view all the answers

    Which diagnostic exam specifies a prep that includes controlling blood sugar and avoiding certain substances for 24 hours?

    <p>PET scan</p> Signup and view all the answers

    Which imaging procedure primarily focuses on observing the functionality of the lower intestines?

    <p>Barium enema</p> Signup and view all the answers

    What is a key reason for monitoring the insertion site after a cardiac catheterization?

    <p>To monitor for bleeding and assess pedal pulses</p> Signup and view all the answers

    Study Notes

    Diagnostic Testing Explained

    • Diagnostic testing is crucial for diagnosing diseases, determining treatment strategies, and evaluating treatment efficacy.
    • Nurses play a vital role in educating patients about diagnostic tests, preparing them for procedures, and assisting healthcare providers during the process.
    • A consent form is typically signed at admission, with additional consents required for invasive procedures and HIV testing.
    • Patients can withdraw consent at any time, even after signing the form.
    • It's the provider's responsibility to comprehensively explain the procedure, its risks, and implications to the patient before obtaining consent.
    • Nurses can clarify points but should seek provider clarification for any complex questions.

    Nursing Responsibilities

    • Nurses ensure informed consent is obtained and documented.
    • They gather necessary supplies and equipment, assist patients during the procedure, and provide comfort and support.
    • Documentation is essential, including patient name, date of birth, medical record number, healthcare provider, date, time, specimen type, and collector's initials.

    General Guidelines for Diagnostic Examinations

    • Nurses should be familiar with baseline vital signs to identify potential complications.
    • Metallic dyes in older tattoos can cause irritation or burns during CT or MRI, so it's crucial to ask about tattoos.
    • Nurses should ensure patients comprehend the test process, potential diagnoses, and cultural considerations.
    • They should inquire about past experiences with diagnostic testing to identify any complications or concerns.
    • Nurses should understand normal test values and potential causes of deviations.
    • They should always follow facility policies and procedures.
    • Medications that can interfere with diagnostic tests or induce arrhythmias should be avoided; examples include digoxin, quinidine, coffee, tea, and tobacco.

    Iodine Allergies

    • Iodine is a common contrast medium in diagnostic imaging.
    • Nurses should thoroughly evaluate patients for iodine allergies, as well as shellfish or shrimp allergies, which are frequently associated with iodine sensitivity.
    • Mild allergic reactions include skin flushing, itching, or hives (urticaria), while severe reactions can progress to anaphylaxis, characterized by hypotension, respiratory distress, and shock.
    • Patients with prior adverse reactions may receive pre-treatment with medications like Valium or steroids.
    • Anaphylaxis is life-threatening, so patients should be closely monitored for two to six hours after the procedure for delayed reactions.
      • Treatment for allergic reactions may include medications like Benadryl, steroids, epinephrine, oxygen, or intubation for respiratory arrest.

    Radiography Terminology

    • Ography: A procedure that involves producing an image, such as a mammogram.
    • Ogram: The actual image or results of a test, like a mammogram.
    • Oscopy: A procedure using a lighted scope to visualize body structures, such as a colonoscopy.
    • Centesis: A procedure involving a puncture of a body cavity to withdraw fluid, examples include paracentesis, thoracentesis, and amniocentesis.

    Plain X-ray Films

    • No special preparation is typically required, other than removing jewelry or clothing with metal, such as underwire bras.
    • Patients may be instructed to hold their breath during chest x-rays.
    • It's crucial to document last menstrual cycles in childbearing women to avoid unnecessary x-rays during potential pregnancy.
    • Examples include chest x-rays, hand x-rays, ankle x-rays, and leg x-rays.

    Contrast X-rays

    • These tests use a contrast medium, often iodine-based, to enhance visibility of organs or structures on imaging.
    • Nurses should assess patients for iodine and shellfish allergies.
    • Following contrast administration, the dye must be excreted, so patients should increase fluid intake.
    • BUN and creatinine levels may be monitored to assess kidney function and ensure proper dye excretion.
    • Common side effects from contrast media include a metallic taste in the mouth, warmth, flushing, and increased urination, which are generally considered normal.

    Contrast X-ray Tests Explained

    • Cholecystogram: Evaluates gallbladder function using contrast media; patients must follow a fat-free meal for supper the night before and remain NPO (nothing by mouth) for an extended period, typically overnight.
    • Myelogram: Assesses the spinal cord and surrounding structures.
      • Requires a consent form, assessment for iodine allergies, and an NPO status for at least four hours prior to the procedure.
      • Patients must empty their bowels and bladder before the test.
      • The dye is injected directly into the spinal canal surrounding the spinal cord.
      • Patients must remain very still during the test.
      • Post-test monitoring includes observing for urinary changes, vital signs, fever, stiff neck, occipital headache, and photophobia, which may indicate meningeal irritation.
      • Prompt notification of the provider is essential for any of these signs.
    • Intravenous Pyelogram (IVP): Visualises the urinary tract (kidneys, bladder, and prostate in males) to diagnose urinary problems.
      • Patients must have a consent form, be NPO after midnight, and may need a laxative preparation dependent on provider instructions.
      • IVP should be performed before barium studies or after barium is cleared from the intestines.
      • Post-test care includes encouraging fluids and monitoring urine output.
    • Brain Scan: Evaluates the brain.
      • Patients must have a consent form, be NPO for four hours, and remove all metal objects from the head and hair.
      • Assessment for iodine and shellfish allergies is crucial.
      • Fluid intake is encouraged post-test.
    • Bone Scan: Analyzes bone structure and function.
      • Patients should remove metal objects and increase fluid intake before and after the test.
      • They may experience slight discomfort during the dye injection.
      • No radioactive precautions are necessary.
    • CT Scan (Computed Tomography): Provides detailed, three-dimensional images of structures.
      • Patients must have a consent form, be NPO for at least four hours, and remove all metal objects.
      • Intravenous contrast is frequently used.
      • Diabetic patients taking metformin or Glucophage who have a high risk for lactic acid buildup must discontinue the medication for 48 hours before and after the test.
      • Patients with favorable kidney, liver, or alcohol abuse histories may not require metformin discontinuation.
      • The provider ultimately decides on the need for metformin discontinuation.
    • Arteriogram: Visualises blood flow in specific areas of the body.
      • Nurses assess for dye allergies.
      • Patients must be NPO for two to eight hours prior to the test and must urinate before the procedure.
      • Post-test care includes bed rest for eight hours, keeping the extremity where the puncture occurred extended, and monitoring the site frequently for pulse and bleeding.
      • A pressure dressing is applied to the puncture site and should never be removed.
      • A diminished pulse requires immediate provider notification.
      • Coagulation studies and any anti-coagulant medication use should be documented.

    Barium Studies

    • Barium studies are diagnostic x-ray exams using barium to examine the GI tract for abnormalities.
    • Patients must be NPO (Nothing by Mouth) after midnight and on clear liquids for lunch and supper.
    • Clients will need to drink a glass of water or clear liquid every 8-10 hours to stay hydrated.
    • After the barium study, a "post-barium lavage" is performed.
    • Patients should expect white stools after the test.
    • Return to a regular diet after the exam.
    • Barium Enema examines the lower intestines.
    • Upper GI examines the stomach, esophagus, duodenum, and upper jejunum.
    • Small bowel series examines the entire bowel.
    • Barium Swallow evaluates swallowing ability and dysphagia. Also, NPO before the test.

    MRI

    • MRI uses a magnetic field to produce detailed 3D images.
    • Contraindicated in people with metallic or metal implants, gold fillings, and pacemakers, as well as those who are claustrophobic.
    • All jewelry, metal objects, and underwire bras should be removed.
    • Patients must remain still during the test; sedation may be required for some individuals.
    • Contrast may be used, but not always required.

    Mammogram

    • It is an x-ray of the breast and may be uncomfortable.
    • Deodorant, powders, lotions, and other products should be removed prior to the test as they can cause false positive results.

    PET Scan

    • Requires a consent form.
    • Looks for cancer by using a radioisotope that goes to areas with faster metabolism, causing those cells to "glow" on the scan.
    • Blood sugar must be controlled, and patients need to avoid alcohol, caffeine, tobacco, sedatives, and tranquilizers for 24 hours prior to the test.
    • Empty the bladder prior to the scan, and encourage fluids after the test.

    Sonogram or Ultrasound

    • Uses sound waves to create images by bouncing off solid structures.
    • Must be done before barium studies or after a post-barium laxative has been administered.
    • Non-invasive.
    • Most patients must be NPO, except for echocardiograms and pelvic sonograms such as those performed during pregnancy.
    • Pelvic or OB sonograms may involve drinking fluids prior to the test to displace the uterus.
    • Patients cannot void during the test.

    Biopsies

    • Invasive procedures requiring a consent form.
    • Sedation may or may not be used.
    • Biopsies provide a definitive diagnosis.

    Liver Biopsy

    • Requires coagulation studies prior to the test to ensure normal bleeding risks.
    • The test may be postponed if blood is too thin.
    • Patients should take a deep breath when the needle is inserted to help with pain and facilitate easier needle insertion.
    • Ultrasound is often used to guide the needle.
    • After the test, apply a pressure dressing, monitor for bleeding, and place the patient on bed rest for 24 hours.
    • Encourage the patient to lay on their right side to decrease bleeding.
    • Avoid strenuous exercise for 1-2 weeks.

    Bone Marrow Aspiration

    • Requires a consent form.
    • A complete blood count is reviewed prior to the test.
    • The iliac crest is the most common aspiration site.
    • Observe the site for bleeding, signs and symptoms of shock, some tenderness is expected, and apply pressure to the puncture site.
    • Resume normal activities if no issues after 30-60 minutes, and take mild analgesics as needed for tenderness.

    Thoracentesis

    • Removal of fluid from the chest cavity.
    • Requires a consent form.
    • Performed for clients with difficulty breathing due to excess fluid.
    • Position patients in an orthopneic position, sitting upright and leaning forward toward the bed table.
    • Local anesthetic is used, and sedation is not generally required.
    • Monitor vital signs after the test for coughing, hemoptysis, and diminished lung sounds.
    • Patients can usually resume normal activity within a few hours if everything goes well.
    • Instruct patients to lay on their unaffected side.

    Lumbar Puncture (Spinal Tap)

    • Removal of spinal fluid.
    • Requires a consent form.
    • Place the patient on their side with knees pulled close to their chest, and their chin down on their chest, aiming for a "C" shape in the back for easier vertebral access.
    • Empty the bladder and bowel prior to the procedure.
    • After the procedure, monitor for mobility, lower extremity numbness or tingling.
    • Patients must remain in a flat position (head of the bed no more than 30 degrees) for a few hours to prevent spinal headache.

    Paracentesis

    • Fluid removal from the abdominal cavity.
    • Requires a consent form.
    • Have the patient urinate prior to the test.
    • Position them supine with the head of the bed slightly elevated.
    • Monitor blood pressure for a potential drop after fluid removal.
    • Measure abdominal girth (at the umbilicus), weight, and vital signs before and after the test.
    • Monitor puncture site for bleeding.

    Amniocentesis

    • Removal of amniotic fluid from the uterus to detect fetal maturity and genetic defects.
    • Requires a consent form.
    • Optimal positioning is on the left side to increase amniotic fluid volume.
    • An ultrasound is performed prior to the procedure to locate the placenta.
    • Monitor fetal heart rate before, during, and after the test.
    • Patients must have a full bladder before 20 weeks of gestation and an empty bladder after 20 weeks.
    • Instruct patient to lie on their left side after the test and notify the provider of any fever or amniotic fluid loss.
    • If the mother is Rh-negative, administer RhoGAM to prevent antibody development against the fetus.

    Endoscopic Exams

    • Exams using a lighted instrument to directly view internal structures.
    • All patients are NPO after midnight and require a consent form.

    EGD (Esophagogastroduodenoscopy)

    • Requires IV sedation and topical anesthesia for the throat.
    • Examines the esophagus, stomach, and duodenum.
    • After the test, monitor for swallowing ability and gag reflex before permitting food or drink.

    Colonoscopy

    • Direct visualization of the colon.
    • Requires a consent form and a bowel preparation with laxatives until clear fluid (no stool) is expelled.
    • IV sedation is used.
    • Monitor vital signs, sedation level, rectal bleeding, abdominal pain, gas pain, and bleeding after the procedure.
    • Encourage fluids to rehydrate after the bowel preparation.

    Bronchoscopy

    • Examination of the lungs with a scope.
    • Sedation and throat numbing are likely.
    • Requires a consent form.
    • Monitor for respiratory distress, coughing, and hemoptysis after the procedure.

    Proctosigmoidoscopy

    • Direct visualization of the lower end of the large intestine.
    • Requires a consent form.
    • Sedation is not typically required as the scope does not go in very far.
    • Laxatives or enemas are used for preparation.
    • Monitor for rectal bleeding after the test.

    Cystoscopy

    • Direct visualization of the bladder.
    • NPO.
    • May be done under general anesthesia (in which case, they are NPO) or topical anesthesia.
    • May involve brief pain during scope insertion.
    • Requires a consent form.
    • Enemas may be ordered to clear the bladder.
    • Post-test monitor for voiding, bleeding, and pain.
    • Encourage fluids.

    Cardiac Catheterization

    • Examines the coronary arteries of the heart.
    • Requires NPO for 4-8 hours prior to the test, IV access, and a consent form.
    • Confirm allergies to shellfish or iodine.
    • After the procedure, monitor insertion site for bleeding, feel for bleeding distally, and monitor vital signs and pedal pulses.
    • Force fluids after the procedure.
    • Patients must lie flat for 4-8 hours.
    • Assess for numbness, tingling, or loss of function in the extremity used.

    EKG (Electrocardiogram)

    • Tracing of the electrical activity of the heart.
    • No special preparation required, except for clean and dry skin with minimal hair.
    • Painless.
    • Placement of leads is important for accuracy.### ECG
    • Patient's arms and chest are fitted with electrodes
    • When all electrodes are in place, a button is pressed to start the ECG
    • Patient must remain still so the trace is easy to read

    Stress Test

    • Done to assess heart activity under physical or pharmacological stress
    • Exercise stress test performed on a treadmill involves monitoring heart activity under stress
    • Test stops if patient experiences chest pain
    • Before an exercise stress test, the patient needs to avoid caffeine and tobacco, be NPO, wear comfortable clothing and shoes, and continue taking their heart medication
    • A drug-induced stress test is known as an Atonson stress test

    Electroencephalogram (EEG)

    • Electrodes are placed on the head
    • Test is conducted in a quiet area
    • The patient's hair should be clean and dry
    • No sedation or hypnotics can be given as they interfere with the test
    • Caffeine intake should be restricted prior to the test

    Diagnostic Testing Explained

    • Diagnostic testing is used to diagnose diseases, determine treatment strategies, and evaluate treatment efficacy
    • Nurses educate patients, prepare them for procedures, and assist healthcare providers during the process
    • A consent form is signed at admission, with additional consents required for invasive procedures and HIV testing
    • Written consent can be withdrawn at any time
    • The provider explains the risks, implications, and process of the procedure before obtaining consent
    • Nurses clarify points, but refer complex questions to the provider

    Nursing Responsibilities

    • Nurses ensure informed consent is obtained and documented
    • They gather supplies, assist patients during the procedure, and provide comfort
    • Documentation includes name, date of birth, medical record number, healthcare provider, date, time, specimen type, and collector's initials

    General Guidelines

    • Nurses should understand baseline vital signs to identify potential complications
    • Assess for allergies to metallic dyes in tattoos as they can cause issues during CT or MRI scans
    • Ensure patients understand the test process, potential diagnoses, and cultural considerations
    • Inquire about past experiences with diagnostic testing to identify complications
    • Nurses should understand normal test values and deviations
    • Avoid medications that interfere with tests, including digoxin, quinidine, coffee, tea, and tobacco

    Iodine Allergies

    • Iodine is a common contrast medium
    • Evaluate for allergies to iodine, shellfish, or shrimp
    • Mild reactions include flushing, itching, or hives
    • Severe reactions can progress to anaphylaxis, characterized by hypotension, respiratory distress, and shock
    • Patients with prior reactions may receive pre-treatment with Valium or steroids
    • Anaphylaxis is life-threatening, monitor patients for two to six hours after the procedure
    • Treatment includes Benadryl, steroids, epinephrine, oxygen, or intubation

    Radiography Terminology

    • Ography: A procedure to produce an image
    • Ogram: The actual image or results
    • Oscopy: A procedure using a lighted scope to visualize body structures
    • Centesis: A procedure involving a puncture of a body cavity to withdraw fluid

    Plain X-ray Films

    • No special preparation required, other than removing jewelry or clothing with metal
    • Patients may be instructed to hold their breath during chest x-rays
    • Document last menstrual cycles for childbearing women to avoid unnecessary x-rays during potential pregnancy

    Contrast X-rays

    • Use a contrast medium, often iodine-based, to enhance visibility
    • Assess patients for iodine and shellfish allergies
    • Following contrast administration, encourage increased fluid intake
    • Monitor BUN and creatinine levels for kidney function

    Contrast X-ray Tests Explained

    • Cholecystogram: Evaluates gallbladder function; patients must follow a fat-free meal the night before and remain NPO for an extended period
    • Myelogram: Assesses the spinal cord; requires a consent form, assessment for iodine allergies, and an NPO status for at least four hours prior to the procedure; empty bowels and bladder; remain very still during the test; monitor for urinary changes, vital signs, fever, stiff neck, occipital headache, and photophobia
    • Intravenous Pyelogram (IVP): Visualises the urinary tract; requires a consent form, NPO after midnight, and possibly a laxative; should be performed before barium studies or after barium is cleared from the intestines; encourage fluids and monitor urine output
    • Brain Scan: Evaluates the brain; requires a consent form, NPO for four hours, and removal of metal objects; assess for iodine and shellfish allergies; encourage fluid intake post-test
    • Bone Scan: Analyzes bone structure; remove metal objects and increase fluid intake before and after the test; slight discomfort during dye injection; no radioactive precautions
    • CT Scan (Computed Tomography): Provides detailed images; requires a consent form, NPO for at least four hours, and removal of metal objects; intravenous contrast is frequently used; diabetic patients taking metformin or Glucophage who have a high risk for lactic acid buildup must discontinue the medication for 48 hours before and after the test
    • Arteriogram: Visualises blood flow; assess for dye allergies; NPO for two to eight hours prior to the test; urinate before the procedure; bed rest for eight hours post-test; keep extremity where the puncture occurred extended; monitor site for pulse and bleeding; a pressure dressing is applied to the puncture site and should never be removed; diminished pulse requires immediate provider notification; document coagulation studies and any anticoagulant medication use

    Barium Studies

    • Uses barium to examine the GI tract for abnormalities
    • Patients must be NPO after midnight and on clear liquids for lunch and supper
    • Drink a glass of water or clear liquid every 8-10 hours to stay hydrated
    • After the barium study, a "post-barium lavage" is performed
    • Expect white stools after the test
    • Return to a normal diet after the exam
    • Barium Enema: Examines the lower intestines
    • Upper GI: Examines the stomach, esophagus, duodenum, and upper jejunum
    • Small bowel series: Examines the entire bowel
    • Barium Swallow: Evaluates swallowing ability and dysphagia; NPO before the test

    MRI

    • Uses a magnetic field to produce detailed 3D images
    • Contraindicated in people with metallic or metal implants, gold fillings, and pacemakers, as well as those who are claustrophobic
    • All jewelry, metal objects, and underwire bras should be removed
    • Remain still during the test; sedation may be required
    • Contrast may be used, but not always required

    Mammogram

    • It is an x-ray of the breast and may be uncomfortable
    • Deodorant, powders, lotions, and other products should be removed prior to the test

    PET Scan

    • Requires a consent form
    • Looks for cancer by using a radioisotope that goes to areas with faster metabolism, causing those cells to "glow" on the scan
    • Blood sugar must be controlled, and patients need to avoid alcohol, caffeine, tobacco, sedatives, and tranquilizers for 24 hours prior to the test
    • Empty the bladder prior to the scan, and encourage fluids after the test

    Sonogram or Ultrasound

    • Uses sound waves to create images by bouncing off solid structures
    • Must be done before barium studies or after a post-barium laxative
    • Non-invasive
    • Most patients must be NPO, except for echocardiograms and pelvic sonograms such as those performed during pregnancy
    • Pelvic or OB sonograms may involve drinking fluids prior to the test to displace the uterus
    • Patients cannot void during the test

    Biopsies

    • Invasive procedures requiring a consent form
    • Sedation may or may not be used
    • Provides a definitive diagnosis

    Liver Biopsy

    • Requires coagulation studies prior to the test
    • May be postponed if blood is too thin
    • Patients should take a deep breath when the needle is inserted
    • Ultrasound is often used to guide the needle
    • After the test, apply a pressure dressing, monitor for bleeding, and place the patient on bed rest for 24 hours
    • Encourage the patient to lay on their right side
    • Avoid strenuous exercise for 1-2 weeks

    Bone Marrow Aspiration

    • Requires a consent form
    • A complete blood count is reviewed prior to the test
    • The iliac crest is the most common aspiration site
    • Observe the site for bleeding, signs and symptoms of shock; some tenderness is expected
    • Apply pressure to the puncture site
    • Resume normal activities if no issues after 30-60 minutes
    • Take mild analgesics as needed for tenderness

    Thoracentesis

    • Removal of fluid from the chest cavity
    • Requires a consent form
    • Performed for clients with difficulty breathing due to excess fluid
    • Position patients in an orthopneic position
    • Local anesthetic is used, and sedation is not generally required
    • Monitor vital signs after the test for coughing, hemoptysis, and diminished lung sounds
    • Resume normal activity within a few hours
    • Instruct patients to lay on their unaffected side

    Lumbar Puncture (Spinal Tap)

    • Removal of spinal fluid
    • Requires a consent form
    • Place the patient on their side with knees pulled close to their chest, and their chin down on their chest, aiming for a "C" shape in the back
    • Empty the bladder and bowel prior to the procedure
    • After the procedure, monitor for mobility, lower extremity numbness or tingling
    • Patients must remain in a flat position for a few hours to prevent spinal headache

    Paracentesis

    • Fluid removal from the abdominal cavity
    • Requires a consent form
    • Have the patient urinate prior to the test
    • Position them supine with the head of the bed slightly elevated
    • Monitor blood pressure for a potential drop after fluid removal
    • Measure abdominal girth, weight, and vital signs before and after the test
    • Monitor puncture site for bleeding

    Amniocentesis

    • Removal of amniotic fluid from the uterus to detect maturity and genetic defects
    • Requires a consent form
    • Optimal positioning is on the left side
    • An ultrasound is performed prior to the procedure to locate the placenta
    • Monitor fetal heart rate before, during, and after the test
    • Patients must have a full bladder before 20 weeks of gestation and an empty bladder after 20 weeks
    • Instruct patient to lie on their left side after the test and notify the provider of any fever or amniotic fluid loss
    • If the mother is Rh-negative, administer RhoGAM to prevent antibody development against the fetus

    Endoscopic Exams

    • Exams using a lighted instrument to directly view internal structures
    • All patients are NPO after midnight and require a consent form

    EGD (Esophagogastroduodenoscopy)

    • Requires IV sedation and topical anesthesia for the throat
    • Examines the esophagus, stomach, and duodenum
    • After the test, monitor for swallowing ability and gag reflex before permitting food or drink

    Colonoscopy

    • Direct visualization of the colon
    • Requires a consent form and a bowel preparation with laxatives until clear fluid is expelled
    • IV sedation is used
    • Monitor vital signs, sedation level, rectal bleeding, abdominal pain, gas pain, and bleeding after the procedure
    • Encourage fluids to rehydrate after the bowel preparation

    Bronchoscopy

    • Examination of the lungs with a scope
    • Sedation and throat numbing are likely
    • Requires a consent form
    • Monitor for respiratory distress, coughing, and hemoptysis after the procedure

    Proctosigmoidoscopy

    • Direct visualization of the lower end of the large intestine
    • Requires a consent form
    • Sedation is not typically required
    • Laxatives or enemas are used for preparation
    • Monitor for rectal bleeding after the test

    Cystoscopy

    • Direct visualization of the bladder
    • NPO
    • Under general anesthesia or topical anesthesia
    • Brief pain during scope insertion
    • Requires a consent form
    • Enemas may be ordered to clear the bladder
    • Post-test monitor for voiding, bleeding, and pain
    • Encourage fluids

    Cardiac Catheterization

    • Examines the coronary arteries of the heart
    • Requires NPO for 4-8 hours prior to the test, IV access, and a consent form
    • Confirm allergies to shellfish or iodine
    • After the procedure, monitor insertion site for bleeding, feel for bleeding distally, and monitor vital signs and pedal pulses
    • Force fluids after the procedure
    • Patients must lie flat for 4-8 hours
    • Assess for numbness, tingling, or loss of function in the extremity used

    EKG (Electrocardiogram)

    • Tracing of the electrical activity of the heart
    • No special preparation required, except for clean and dry skin with minimal hair
    • Painless
    • Placement of leads is important for accuracy

    ECG

    • Patient's arms and chest are fitted with electrodes
    • When all electrodes are in place, a button is pressed to start the ECG
    • Patient must remain still so the trace is easy to read

    Stress Test

    • Done to assess heart activity under physical or pharmacological stress
    • Exercise stress test performed on a treadmill involves monitoring heart activity under stress
    • Test stops if patient experiences chest pain
    • Before an exercise stress test, the patient needs to avoid caffeine and tobacco, be NPO, wear comfortable clothing and shoes, and continue taking their heart medication
    • A drug-induced stress test is known as an Atonson stress test

    Electroencephalogram (EEG)

    • Electrodes are placed on the head
    • Test is conducted in a quiet area
    • The patient's hair should be clean and dry
    • No sedation or hypnotics can be given as they interfere with the test
    • Caffeine intake should be restricted prior to the test

    Diagnostic Testing and Nursing

    • Diagnostic tests help healthcare providers diagnose patients, plan treatment, and monitor treatment effectiveness.
    • Nurses are crucial in facilitating diagnostic tests, ensuring patient safety, and providing education and support.
    • Informed consent is required for most tests; patients can withdraw consent at any time.
    • Nurses play a vital role in educating patients about tests and preparing them for procedures.
    • Nurses are responsible for collecting and labeling specimens for laboratory analysis, following procedures and sterile techniques.
    • Nurses must document all procedures and patient responses in the medical record.

    Preparing Patients for Diagnostic Testing

    • Nurses must verify provider prescriptions and ensure informed consent is obtained.
    • Ensure the patient fully understands the procedure and its implications.
    • Gather necessary supplies and equipment.
    • Introduce yourself, identify the patient, and explain the procedure.
    • Prepare the patient by positioning and cleansing the area.
    • Perform hand hygiene and wear clean gloves.
    • Label specimens correctly and accurately.
    • Assist healthcare providers as needed and document the procedure.

    General Guidelines for Diagnostic Tests

    • Know and assess the patient's baseline vital signs to monitor for complications.
    • Be aware of potential complications related to allergies or past medical history.
    • Inform the provider of any potential issues with the test or the patient's history.
    • Understand normal test results and recognize deviations from normal.
    • Identify and avoid medications that may interfere with diagnostic testing, such as digoxin, quinidine, caffeine, tea, and tobacco.

    Iodine Allergies and Contrast Media

    • Assess for iodine allergies, shellfish, or shrimp allergies before administering contrast media.
    • Monitor for signs of allergic reaction, including mild flushing, itching, hives, or anaphylaxis.
    • Have emergency equipment readily available in cases of anaphylaxis.
    • Observe patients for delayed reactions after the procedure.
    • Treatment for iodine allergy reactions may include Benadryl, steroids, epinephrine, oxygen, and intubation for respiratory arrest.

    Radiography Types and Preparations

    • Plain X-rays:
      • No special preparation required.
      • Remove jewelry and metallic clothing, including metal underwire bras.
      • Instruct patients to take deep breaths and hold them during chest x-rays.
      • Obtain information about the last menstrual cycle for women of childbearing age due to potential radiation effects on fetuses.
    • Contrast X-rays:
      • Assess for iodine and shellfish allergies.
      • Encourage hydration after the test to flush out contrast dye.
      • May require BUN and creatinine lab tests to assess kidney function.
      • Normal reactions include a metallic taste, warmth, flushing, and urge to urinate.
      • Power injectors may be used to automatically administer the dye.
    • Cystogram:
      • Used to visualize the gallbladder.
      • Requires a fat-free supper the night before the test, including tea, toast, and jelly.
      • Patients must be NPO (nothing by mouth) for extended periods.
    • Myelogram:
      • Used to visualize the spinal cord.
      • Patients require a consent form and assessment for iodine allergies.
      • Must be NPO at least four hours prior to the test.
      • Bowel and bladder preparation is required.
      • Dye is injected directly into the spinal canal.
      • Encourage fluids after the test.
      • Monitor voiding, vital signs, and watch for fever, stiff neck, occipital headache, and photophobia which could indicate meningeal irritation.
    • Intravenous Pyelogram:
      • Examines the urinary bladder, kidneys, and prostate (in males).
      • Patients must be NPO past midnight.
      • May require a laxative pre-test as prescribed by the provider.
      • Encourage fluids after the test.
      • Monitor urinary output.
      • May require BUN and creatinine tests following the test.
    • Brain Scan:
      • Requires a consent form.
      • Patients must be NPO for four hours prior to the procedure.
      • Remove all metal objects from the hair and head, including removable dental appliances.
      • Assess for allergies to dye (iodine and shellfish).
      • Encourage fluids after the test.
    • Bone Scan:
      • Encourage extra fluids before and after the test.
      • Remove all metallic objects.
      • Expect discomfort during the dye injection.
      • No radioactive precautions are required.
    • Computed Tomography (CT) Scan:
      • Alternative name for CT scan: Computed Tomography.
      • Patients must be NPO for at least four hours before the test.
      • Requires a consent form.
      • Remove all metallic objects.
      • Encourage fluids after the test.
      • Diabetics taking metformin or glucophage may need to discontinue use for 48 hours before the test due to risk of lactic acid buildup.
      • Patients at high risk for complications, such as those with kidney or liver issues or a history of alcohol abuse, should discontinue metformin for 48 hours, but providers determine this.
    • Arteriogram:
      • Visualizes blood flow through various parts of the body.
      • Assess for allergies to dye.
      • Patients must be NPO for two to eight hours.
      • Encourage urination prior to the test.
      • Bed rest for eight hours post-test, with the affected extremity extended to decrease bleeding.
      • Monitor pulses frequently (every 15 minutes for the first four hours, then every 30 minutes) and notify the provider if diminished pulses are detected.
      • Ensure completion of coagulation studies before the test and note if the patient is using anticoagulants.
      • Place a pressure dressing on the puncture site to minimize bleeding.
      • Never remove the pressure dressing.

    Additional Diagnostic Tests

    • Cardiac Catheterization:
      • Used to evaluate heart function, identify blockages, and assess the effectiveness of treatment.
      • The cardiologist performs the procedure.
      • Ensure the patient understands and signs the informed consent.
      • Requires specific pre-procedure preparation (e.g., NPO, medications, shaving the procedure site).
      • Post-procedure care includes bedside monitoring for vital signs, urine output, and cardiac rhythm.
    • Endoscopy Procedures:
      • Esophagogastroduodenoscopy (EGD): Visualizes the esophagus, stomach, and duodenum.
      • Colonoscopy: Visualizes the rectum, sigmoid colon, and descending colon.
      • Bronchoscopy: Visualizes the trachea and bronchi.
      • Cystoscopy: Visualizes the inside of the bladder.
      • Laryngoscopy: Visualizes the larynx.
      • Arthroscopy: Visualizes joints.
      • Laparoscopy: Visualizes the abdomen.
      • All require consent forms, NPO status prior to the procedure, and follow-up care after the procedure.
    • Ultrasound Procedures:
      • Abdominal Ultrasound: Visualizes the abdominal organs.
      • Pelvic Ultrasound: Visualizes the female reproductive organs and bladder.
      • Cardiac Ultrasound (Echocardiogram): Visualizes the heart and its function.
      • Doppler Ultrasound: Uses soundwaves to assess blood flow.
      • Transvaginal Ultrasound: Performed by inserting a probe into the vagina.
      • All require informed consent, a full bladder for abdominal scans, and potential dietary or fluid restrictions for some tests.
    • Magnetic Resonance Imaging (MRI):
      • Uses radio waves to create images of the body's organs.
      • Requires informed consent.
      • Patients with metal implants, pacemakers, or other magnetically sensitive devices cannot undergo MRIs.
      • Patients should avoid caffeine, alcohol, and nicotine before the procedure.
      • Patients should wear comfortable, loose-fitting clothing.
      • The procedure can be noisy and may require the patient to lie still.

    Barium Studies

    • Diagnostic x-ray exams that use barium to examine the gastrointestinal tract for abnormalities.
    • Prep: Must be NPO after midnight, clear liquids for lunch and supper.
    • Post-test: Must have post-barium laxative to prevent constipation and impaction.
    • Types of Barium Studies:
      • Barium Enema (Lower intestines).
      • Upper GI (Stomach, esophagus, duodenum, upper jejunum).
      • Small Bowel Series (Entire bowel).
      • Barium Swallow (Evaluates swallowing ability).

    MRI

    • Uses a magnetic field to produce detailed 3D pictures.
    • Contraindications: Metallic or metal implants, pacemakers, claustrophobia.
    • Prep: Remove all jewelry and metal objects (bra underwire), remain absolutely still.

    Mammogram

    • X-ray of the breast.
    • Prep: No deodorant, powders, or lotions on the breast.
    • Uncomfortable: Breast must be flattened to allow for visualization of lesions.

    PET Scan

    • Uses a radioisotope that goes to areas with faster metabolism to detect cancer.
    • Prep: Blood sugar needs to be controlled, no alcohol, caffeine, tobacco, sedatives, or tranquilizers for 24 hours prior to the test.
    • Post-test: Encourage fluids.

    Sonograms

    • Noninvasive tests that use sound waves to create a picture of internal structures.
    • Prep: Must be done before barium studies or after post-barium laxatives.
    • Exceptions:
      • Echocardiogram (Heart).
      • Pelvic/OB Sonograms (May require fluid intake).
      • Liver & Gallbladder Abdominal Studies (Must be NPO).

    Biopsies

    • Invasive procedures that take a sample of tissue for microscopic examination.
    • Prep:
      • Requires consent form.
      • May or may not get sedation.
      • Coagulation studies for liver biopsies.
    • Post-test:
      • Pressure dressing is applied.
      • Monitor for bleeding, vital signs, and complications (e.g., hemothorax).
      • Rest restrictions.

    Fluid Removal

    • Thoracentesis: Removal of fluid from the chest cavity; often用于肺癌患者. 
    • Prep: Consent form, orthopneic position. 
    • Post-test: Monitor vital signs, lung sounds, and potential complications (e.g., pneumothorax).
    • Lumbar Puncture: Removal of spinal fluid (Spinal Tap). 
      • Prep: Consent form, lying on side with knees bent and pulled up to chest, empty bladder. 
      • Post-test: Monitor for mobility, numbness/tingling in lower extremities, and potential complications (e.g., spinal headaches).
    • Paracentesis: Removal of fluid from the abdominal cavity. 
      • Prep: Consent form, supine or head of bed slightly elevated, empty bladder. 
      • Post-test: Monitor vital signs, abdominal girth, and potential complications (e.g., bleeding).

    Amniocentesis

    • Used to assess fetal maturity and detect fetal abnormalities.
    • Prep: Consent form, left side lying position, ultrasound beforehand, check fetal heart rate.
    • Post-test: Monitor for fever, fluid leakage, and potential complications (e.g., bleeding).

    Scopic Exams

    • Invasive exams that use lighted instruments to view internal structures.
    • Prep: NPO after midnight, consent form.
    • EGD (Esophagogastroduodenoscopy): Views the esophagus, stomach, and duodenum.
    • Prep: IV sedation, topical anesthetic for throat.
      • Post-test: Monitor for swallowing ability, gag reflex.
    • Colonoscopy: Views the colon (large intestine).
      • Prep: Bowel prep with laxatives until clear fluid.
      • Post-test: Monitor vital signs, rectal bleeding, and potential complications (e.g., hemorrhage).
    • Bronchoscopy: Views the lungs.
      • Prep: May have sedation, topical anesthetic for throat.
      • Post-test: Monitor for respiratory distress, coughing, and potential complications (e.g., hemoptysis).
    • Proctosigmoidoscopy: Views the lower end of the large intestine.
      • Prep: Laxatives or enemas, may have sedation.
      • Post-test: Monitor for vital signs and rectal bleeding.
    • Cystoscope: Views the bladder.
      • Prep: NPO if done under general anesthesia, enemas may be ordered.
      • Post-test: Monitor urination, bleeding, and potential complications (e.g., pain).

    Cardiac Catherization

    • Arteriogram specifically for the heart; uses dye to visualize coronary arteries.
    • Prep: NPO 4-8 hours, consent form, IV access, check allergies to shellfish or iodine.
    • Post-test: Monitor insertion site for bleeding, vital signs, pedal pulses, and potential complications (e.g., numbness, tingling, or loss of function in the extremity).
    • Rest restrictions: Lie flat for 4-8 hours after the procedure.

    Miscellaneous Exams

    • EKG: Traces the electrical activity of the heart; no special prep needed.
    • No pain involved, but skin needs to be clean, dry, and hair-free.

    ECG

    • Requires electrodes on the chest and both arms.
    • A button initiates the process and a print-out is produced.
    • Patients must remain still for clear readings.

    Stress Test

    • Evaluates heart activity under stress.
    • Can be induced by exercise or medication (atison stress test).
    • Exercise stress test is performed on a treadmill.
    • Test is stopped in case of chest pain.
    • Patients should avoid caffeine and tobacco, and arrive NPO (nothing by mouth).
    • Wear comfortable clothing and shoes for exercise.
    • Do not discontinue heart medication prior to the test.

    EEG

    • Evaluates brain electrical activity.
    • Performed in a quiet environment.
    • Non-invasive process.
    • Hair must be clean and dry.
    • Electrodes are placed across the scalp to obtain readings.
    • Avoid sedatives, hypnotics, and caffeine before the test.

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    Explore the critical role of nurses in diagnostic testing and informed consent. This quiz covers key responsibilities, patient education, and the importance of obtaining consent for procedures. Test your knowledge on these essential nursing practices.

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