,TESTBANK for Davis's Comprehensive Manual of
Laboratory and Diagnostic Tests With Nursing
Implications 11th Edition Van Leeuwen
Notes
1- The file is chapter after chapter.
2- We have shown you few pages sample.
3- The file contains all Appendix and Excel sheet
if it exists.
4- We have all what you need, we make update
at every time. There are many new editions
waiting you.
5- If you think you purchased the wrong file You
can contact us at every time, we can replace it
with true one.
Our email:
,Van Leeuwen: Davis's Comprehensive Manual Lab & Dx Tests 11e 1
Test Bank - Circulatory System
Circulatory System
1. A patient is identified as having an increased risk for stroke. Which type of angiography
should be performed to detect this condition?
1. Abdominal
2. Adrenal
3. Carotid
4. Coronary
2. A patient diagnosed with coronary artery disease begins therapy with simvastatin. Which
laboratory result should the nurse monitor to determine the effectiveness of this treatment?
1. Aspartate aminotransferase
2. Alkaline phosphatase
3. Alanine aminotransferase
4. Total cholesterol
3. A patient is suspected of having granulomatosis with polyangiitis. Which antibody test should
the nurse expect to conduct on this patient to confirm this suspicion?
1. Anticyclic citrullinated peptide (anti-CCP)
2. Antiglomerular basement membrane (anti-GBM)
3. Actin (smooth muscle) and mitochondrial M2
4. Perinuclear antineutrophil cytoplasmic antibody (p-ANCA)
4. A nurse is reviewing a newborn patient’s arterial blood gas. Which pH result should the nurse
identify as a “critical” value that should be reported immediately to the health-care provider?
1. 7.12
2. 7.29
3. 7.36
4. 7.6
5. A patient is undergoing venipuncture for collection of a blood sample for apolipoprotein
testing. Which condition is this type of testing useful in identifying?
1. Coronary artery disease
2. Joint disease
3. Chronic obstructive pulmonary disease (COPD)
4. Hepatitis
6. A nurse is preparing to discharge a patient from the hospital who has been diagnosed and
treated for heart failure. The patient has a B-type natriuretic peptide level of 445 picograms
per milliliter (SI = 445 nanograms per liter). When preparing discharge teaching for this
patient, which medication will the nurse likely discuss?
1. Acetaminophen
,Van Leeuwen: Davis's Comprehensive Manual Lab & Dx Tests 11e 2
Test Bank - Circulatory System
2. Angiotensin-converting enzyme (ACE) inhibitor
3. Enoxaparin [CA = enoxaparin sodium]
4. Warfarin [CA = warfarin sodium]
7. A nurse observes that a patient’s potassium level is 5.5 milliequivalents per liter (SI = 5.5
millimoles per liter). Which action should the nurse first take in response to this potassium
level?
1. Assess the patient’s apical heart rate and cardiac rhythm.
2. Instruct the patient to increase intake of foods containing potassium.
3. Monitor patient for polyuria, malaise, and thirst.
4. Notify the requesting health-care provider.
8. A patient has a homocysteine level of 25 micromoles per liter. Which additional laboratory
results should a nurse review to determine whether the patient needs nutritional education?
1. Complement C3 and C4
2. Cholesterol and triglyceride levels
3. Serum creatinine and BUN
4. Urinary sodium
9. A patient is undergoing venipuncture for collection of a specimen for B-type natriuretic
peptide (BNP) testing. Which condition is this test used to diagnose and monitor?
1. Stroke
2. Alzheimer disease
3. Congestive heart failure (CHF)
4. Type 2 diabetes
10. An older adult patient is admitted with hyponatremia and a decreased serum osmolality. When
planning care, which of the following should the nurse have the patient avoid?
1. Sodium
2. Potassium
3. Chloride
4. Water
11. A patient with a history of coronary artery disease reports persistent muscle aches. Laboratory
results show a creatine kinase (CK) level of 360 units per liter with normal transaminase levels
(ALT and AST). Which medication should the nurse relate to this finding?
1. Atorvastatin [CA = atorvastatin calcium]
2. Digoxin
3. Metformin [CA = metformin hydrochloride]
4. Tenormin [CA = atenolol]
,Van Leeuwen: Davis's Comprehensive Manual Lab & Dx Tests 11e 3
Test Bank - Circulatory System
12. Which dietary instruction should a nurse plan for a patient who has a triglyceride level of 300
milligrams per deciliter (SI = 3.4 millimoles per liter)?
1. “Avoid monounsaturated and polyunsaturated fats.”
2. “Decrease intake of omega-3 fatty acids, such as those found in fish.”
3. “Eliminate all dairy products.”
4. “Reduce or avoid intake of alcoholic beverages.”
13. A young woman with a significant family history of coronary artery disease is planning to
become pregnant in the next year. Prenatal screening results show a homocysteine level of 36
micromoles per liter. What should the nurse teach the patient?
1. Take folic acid and vitamins B6 and B12 daily.
2. Decrease intake of calcium and monounsaturated fats.
3. Increase fluid intake and take an aspirin daily.
4. Schedule monthly injections of B12 and iron.
14. Laboratory results indicate that a patient’s anion gap is 20 millimoles per liter. Which
condition should the nurse plan to manage?
1. Appendicitis
2. Metabolic acidosis
3. Myocardial infarction
4. Pulmonary embolism
15. A mother brings her infant to the emergency department reporting that the infant had a seizure.
While taking the health history, a nurse learns that the mother has been short of money and
has been diluting the infant’s formula with more water than the instructions recommend.
Based on this information, which laboratory result should the nurse anticipate?
1. Blood glucose 102 milligrams per deciliter (SI = 5.7 millimoles per liter)
2. Chloride 104 milliequivalents per liter (SI = 104 millimoles per liter)
3. Potassium 4.1 milliequivalents per liter (SI = 4.1 millimoles per liter)
4. Sodium 125 milliequivalents per liter (SI = 125 millimoles per liter)
16. A patient is admitted to the hospital with a diagnosis of confusion. The patient has a serum
digoxin level of 3.2 nanograms per milliliter (SI = 4.1 nanomoles per liter). Which additional
laboratory data should the nurse monitor?
1. BUN level
2. Serum potassium level
3. Hematocrit level
4. Serum sodium level
17. A postoperative patient who has not had oral intake for several days and is receiving D5W at
125 milliliters per hour reports nausea and new onset of a persistent headache. Which
laboratory value should the nurse identify as the cause for this clinical presentation?
1. Creatinine 1.1 milligrams per deciliter (SI = 97.2 micromoles per liter)
,Van Leeuwen: Davis's Comprehensive Manual Lab & Dx Tests 11e 4
Test Bank - Circulatory System
2. Serum potassium 5.2 milliequivalents per liter (SI = 5.2 millimoles per liter)
3. Serum sodium 125 milliequivalents per liter (SI = 125 millimoles per liter)
4. Urine sodium 122 milliequivalents per 24 hours (SI = 122 millimoles per liter)
18. The nurse should assess for hypomagnesemia in which patient?
1. A patient with a history of chronic alcoholism
2. A patient with hyperkalemia
3. A patient who ingested antacids containing magnesium
4. A patient who maintains a vegetarian diet
19. A patient has orders for serial troponin levels on admission and then every 6 hours times three.
The initial troponin level is 8 nanograms per milliliter, and 6 hours later the troponin level is
168 nanograms per milliliter. Based on this result, the nurse should plan care for which
diagnosis?
1. Acute myocardial infarction (MI)
2. Pulmonary embolism (PE)
3. Chronic obstructive pulmonary disease (COPD)
4. Deep vein thrombosis (DVT)
20. A nurse is collecting an arterial blood sample for a lactic acid level. Which action should the
nurse take to ensure that the specimen provides an accurate result?
1. Assist the patient to ambulate immediately prior to collecting the specimen.
2. Ensure that the specimen is mixed well by agitating the tube at least 30 seconds.
3. Remove oxygen for at least 10 minutes before obtaining the specimen.
4. Place the specimen on ice and transport to the laboratory immediately.
21. An adolescent patient is brought to an urgent care center with reports of increasing weakness
and persistent vomiting for 3 days. Which finding in a blood gas analysis should the nurse
expect?
1. pH 7.32; PCO2 50 millimeters of mercury (SI = 50 kPa); HCO3 20 millimoles per liter
2. pH 7.4; PCO2 40 millimeters of mercury (SI = 40 kPa); HCO3 23 millimoles per liter
3. pH 7.47; PCO2 44 millimeters of mercury (SI = 44 kPa); HCO3 30 millimoles per liter
4. pH 7.6; PCO2 30 millimeters of mercury (SI = 30 kPa); HCO3 24 millimoles per liter
22. A nurse is preparing to draw an arterial sample for blood gas analysis. Which equipment
should the nurse have available?
1. High-flow oxygen facemask
2. Ice slurry in a cup or plastic bag
3. Tourniquet
4. Red-topped Vacutainer tube
,Van Leeuwen: Davis's Comprehensive Manual Lab & Dx Tests 11e 5
Test Bank - Circulatory System
23. A nurse is attempting to insert a needle to obtain a blood specimen, but the patient is exhibiting
signs of a vasovagal reaction. Which problem should the nurse be most concerned about?
1. Fear related to venipuncture
2. Potential for a fall injury
3. Pain related to venipuncture
4. Risk for impaired skin integrity
24. A patient has had a myocardial infarction and needs to undergo testing to evaluate the damage
to the myocardium. Which test would be appropriate for this purpose?
1. Thyroxine, free
2. Triiodothyronine, free
3. Thyroid-stimulating hormone (TSH)
4. Troponins I and T
25. An 80-year-old patient has a carotid ultrasound that shows stenosis of 40% to 60% and a
moderate amount of plaque. Which nursing action is appropriate for this patient?
1. Advise the patient that surgery is indicated as soon as possible.
2. Avoid use of aspirin or products containing aspirin.
3. Instruct the patient to report any changes in speech, balance, or vision.
4. Recommend that the patient restrict activity until medication decreases the stenosis.
26. When collecting any specimen for laboratory analysis, which is the priority action by the
nurse?
1. Communicating with the patient about the prescribed laboratory test
2. Identifying the patient with the health-care facility’s two person-specific identifiers
3. Informing the patient about the purpose of the specimen collection
4. Labeling the specimen with the patient’s name, room number, or address
27. A patient with persistent pleural edema is scheduled for magnetic resonance imaging (MRI)
of the chest. Which information in the patient’s medical history should the nurse identify as
a contraindication for this procedure?
1. Allergy to shellfish
2. Implanted cardiac pacemaker
3. Bilateral breast implants
4. Tattoo on a lower extremity
28. A nurse is collecting blood from a patient for a B-type natriuretic peptide test. This test will
assist in diagnosing which condition?
1. Heart failure
2. Stroke
3. Leukemia
4. Chronic obstructive pulmonary disease (COPD)
,Van Leeuwen: Davis's Comprehensive Manual Lab & Dx Tests 11e 6
Test Bank - Circulatory System
29. During collection of a venous blood sample, a nurse finds it difficult to locate a patient’s vein
while wearing gloves. Which action by the nurse is appropriate?
1. Identify landmarks where the vein is palpable and attempt venipuncture with gloves on.
2. Obtain assistance from another nurse to perform venipuncture.
3. Remove one glove from the dominant hand to palpate the vein.
4. Tear off two fingertips from the glove to make them accessible for palpation.
30. A nurse is preparing to perform venipuncture on a 6-month-old infant with anemia. The infant
has had multiple specimens drawn over an extended hospitalization. The mother is very
anxious and tells the nurse that she does not want any more blood drawn because it is too
upsetting. Which response by the nurse is most appropriate?
1. “I am sure you think this is best for your child, but you are interfering with treatment by
refusing this test.”
2. “If you are sure you do not want the test done, I will call your health-care provider to get
it cancelled. It is up to you.”
3. “Your health-care provider ordered this test, so I am sure you want to have it done or your
health-care provider will not be able to do what is best for your child.”
4. “We all want what is best for your child. Tell me more about why you are upset now.”
31. A patient admitted to an emergency department with trauma after a motorcycle accident needs
blood drawn. The patient has a fracture of the right arm that is splinted, lacerations of both
legs, and IV fluids infusing in the left antecubital space. Which intervention is most
appropriate for the nurse to collect the required blood specimens?
1. Access a vein in the foot for specimen collection.
2. Request insertion of a central line to use for blood collection and IV access as needed.
3. Stop the IV infusion for 2 minutes and then access a site below the IV.
4. Use a butterfly needle to access a vein in the right hand.
32. The nurse recognizes that which patient should have a computed tomography (CT) scan for
cardiac scoring?
1. 30-year-old-female, overweight, high-stress occupation, total cholesterol 110 milligrams
per deciliter (SI = 2.8 millimoles per liter)
2. 45-year-old male, type 2 diabetes, sedentary lifestyle, high-density lipoprotein (HDL)
cholesterol 35 milligrams per deciliter (SI = 0.9 millimoles per liter)
3. 60-year-old female with no family history of heart disease, active lifestyle, nonsmoker
4. 70-year-old male, participates in senior triathlons, body mass index (BMI) 21.2, history
of hypertension
33. Which statement or question by a nurse will ensure that a specimen is obtained from the
correct patient?
1. “Are you [state patient’s full name]?”
2. “I am comparing the name on your armband with this lab requisition form.”
3. “Please state your full name and birth date.”
4. “What test did your health-care provider order for you?”
,Van Leeuwen: Davis's Comprehensive Manual Lab & Dx Tests 11e 7
Test Bank - Circulatory System
34. A patient with a family history of early-onset coronary artery disease is tested for
apolipoprotein A and B (apo A and apo B). The patient has concerns about the need for another
blood test. Which is the best response by the nurse when the patient asks about the purpose of
the apolipoprotein test?
1. “A high apolipoprotein level means that you are more likely to respond to diet changes
and medications to control your cholesterol.”
2. “As long as you do not have symptoms, this test is just a way to monitor your overall
health, so you should not worry about it.”
3. “Knowing your apolipoprotein helps your health-care provider better determine your risk
for coronary artery disease when you have a high triglyceride level.”
4. “This is just one more test that your health-care provider wants, so you should do it
because it could be important.”
35. Which observation by a nurse indicates that a scheduled venous Doppler study is
contraindicated for this patient?
1. Contact isolation
2. Receiving patient-controlled analgesia (PCA) for chronic back pain
3. Restless, confused, and needs frequent reminders to remain in bed
4. Venous stasis ulcer on both lower extremities
36. A nurse is preparing to collect a blood specimen from an 8-year-old patient who requires
frequent venipuncture related to a chronic illness. The patient is anxious and pulls his arm
away as the nurse begins the prep for the procedure. Which action by the nurse is most
appropriate?
1. Apply a topical anesthetic such as EMLA and reassure the patient that the venipuncture
will not hurt.
2. Ask the child’s parent to restrain the patient during the procedure.
3. Involve the child in the procedure by asking him to help by holding the gauze and bandage
to use after the specimen is collected.
4. Request assistance from another staff member to restrain the patient.
37. A nurse is collecting a capillary specimen for blood glucose from a patient on an insulin drip
to treat postoperative hyperglycemia. The patient reports pain from the multiple, hourly
fingersticks required by the intensive insulin protocol. Which action by the nurse is
appropriate?
1. Decrease the frequency of the fingerstick to every other hour.
2. Alternate sites by using the great toe on either foot instead of the fingers.
3. Use the earlobe or forearm as alternate sites.
4. Ensure that the puncture is not on the finger pad and avoid bruised areas.
38. A patient who recently completed a multigated acquisition (MUGA) scan asks what it means
that the test showed an ejection fraction of 65%. Which answer by the nurse is accurate?
1. “This scan shows that your heart was affected by a heart attack at some point, because
your ejection fraction is below average.”
, Van Leeuwen: Davis's Comprehensive Manual Lab & Dx Tests 11e 8
Test Bank - Circulatory System
2. “The ejection fraction shows the effectiveness of the pumping function of the ventricles.
A normal ejection fraction is 55% to 70%.”
3. “Because the ejection fraction is so low, these results indicate that your heart does not
pump as effectively as it should when you are exercising.”
4. “Your health-care provider will follow up with you, but your results will require treatment
because your ejection fraction was so high.”
39. A nurse is collecting blood specimens from an older adult patient with small veins that
collapse or disappear when the nurse tries to insert the needle. The patient has IV fluids
infusing through a peripherally inserted central catheter (PICC) in the left antecubital area.
After two attempts in the right antecubital space using a Vacutainer, the nurse is unable to
obtain the required specimens. Which action is appropriate for the nurse to take next?
1. Attempt again using a syringe attached to a butterfly needle.
2. Confirm the institutional policy regarding the use of a PICC for specimen collection.
3. Request assistance from another nurse to attempt venipuncture again.
4. Use a 5-milliliters syringe to withdraw a sample from the Y-port closest to the patient’s
PICC insertion point.
40. A patient admitted with a fever of unknown origin has orders for “blood cultures ´ 3.” The
nurse should inform the patient that this procedure involves which of the following?
1. Collecting three samples daily in the morning, with one venipuncture when other daily
blood work is obtained
2. Obtaining three samples from different sites, with each sample requiring venipuncture
3. Obtaining sufficient blood to prepare three sets of culture vials with one venipuncture
4. Using random specimens, collected at the time other blood samples are obtained, to
minimize the number of venipunctures required
41. A nurse is preparing to draw blood from a patient who is hearing impaired. Which action by
the nurse is most appropriate?
1. Ask a family member whether the patient will cooperate with the procedure.
2. Discuss the procedure and the patient’s preferences with a family member who is
proficient in sign language before beginning the procedure.
3. Face the patient while explaining the procedure to a qualified sign language interpreter
provided by the facility.
4. Provide written information and use a whiteboard so the patient can communicate without
violating the patient’s privacy.
42. A patient diagnosed with heart failure has a B-type natriuretic peptide (BNP) level of 945
picograms per milliliter (SI = 945 nanograms per liter) upon admission to the hospital. At
discharge, the patient’s BNP is 435 picograms per milliliter (SI = 435 nanograms per liter).
Which discharge instruction is most important for the nurse to share with the patient?
1. “Have additional pillows available in case you have increased dyspnea at night.”
2. “Maintain bedrest if there is any edema of the ankles or feet.”
3. “Monitor weight daily and report weight gain immediately to the health-care provider.”
Laboratory and Diagnostic Tests With Nursing
Implications 11th Edition Van Leeuwen
Notes
1- The file is chapter after chapter.
2- We have shown you few pages sample.
3- The file contains all Appendix and Excel sheet
if it exists.
4- We have all what you need, we make update
at every time. There are many new editions
waiting you.
5- If you think you purchased the wrong file You
can contact us at every time, we can replace it
with true one.
Our email:
,Van Leeuwen: Davis's Comprehensive Manual Lab & Dx Tests 11e 1
Test Bank - Circulatory System
Circulatory System
1. A patient is identified as having an increased risk for stroke. Which type of angiography
should be performed to detect this condition?
1. Abdominal
2. Adrenal
3. Carotid
4. Coronary
2. A patient diagnosed with coronary artery disease begins therapy with simvastatin. Which
laboratory result should the nurse monitor to determine the effectiveness of this treatment?
1. Aspartate aminotransferase
2. Alkaline phosphatase
3. Alanine aminotransferase
4. Total cholesterol
3. A patient is suspected of having granulomatosis with polyangiitis. Which antibody test should
the nurse expect to conduct on this patient to confirm this suspicion?
1. Anticyclic citrullinated peptide (anti-CCP)
2. Antiglomerular basement membrane (anti-GBM)
3. Actin (smooth muscle) and mitochondrial M2
4. Perinuclear antineutrophil cytoplasmic antibody (p-ANCA)
4. A nurse is reviewing a newborn patient’s arterial blood gas. Which pH result should the nurse
identify as a “critical” value that should be reported immediately to the health-care provider?
1. 7.12
2. 7.29
3. 7.36
4. 7.6
5. A patient is undergoing venipuncture for collection of a blood sample for apolipoprotein
testing. Which condition is this type of testing useful in identifying?
1. Coronary artery disease
2. Joint disease
3. Chronic obstructive pulmonary disease (COPD)
4. Hepatitis
6. A nurse is preparing to discharge a patient from the hospital who has been diagnosed and
treated for heart failure. The patient has a B-type natriuretic peptide level of 445 picograms
per milliliter (SI = 445 nanograms per liter). When preparing discharge teaching for this
patient, which medication will the nurse likely discuss?
1. Acetaminophen
,Van Leeuwen: Davis's Comprehensive Manual Lab & Dx Tests 11e 2
Test Bank - Circulatory System
2. Angiotensin-converting enzyme (ACE) inhibitor
3. Enoxaparin [CA = enoxaparin sodium]
4. Warfarin [CA = warfarin sodium]
7. A nurse observes that a patient’s potassium level is 5.5 milliequivalents per liter (SI = 5.5
millimoles per liter). Which action should the nurse first take in response to this potassium
level?
1. Assess the patient’s apical heart rate and cardiac rhythm.
2. Instruct the patient to increase intake of foods containing potassium.
3. Monitor patient for polyuria, malaise, and thirst.
4. Notify the requesting health-care provider.
8. A patient has a homocysteine level of 25 micromoles per liter. Which additional laboratory
results should a nurse review to determine whether the patient needs nutritional education?
1. Complement C3 and C4
2. Cholesterol and triglyceride levels
3. Serum creatinine and BUN
4. Urinary sodium
9. A patient is undergoing venipuncture for collection of a specimen for B-type natriuretic
peptide (BNP) testing. Which condition is this test used to diagnose and monitor?
1. Stroke
2. Alzheimer disease
3. Congestive heart failure (CHF)
4. Type 2 diabetes
10. An older adult patient is admitted with hyponatremia and a decreased serum osmolality. When
planning care, which of the following should the nurse have the patient avoid?
1. Sodium
2. Potassium
3. Chloride
4. Water
11. A patient with a history of coronary artery disease reports persistent muscle aches. Laboratory
results show a creatine kinase (CK) level of 360 units per liter with normal transaminase levels
(ALT and AST). Which medication should the nurse relate to this finding?
1. Atorvastatin [CA = atorvastatin calcium]
2. Digoxin
3. Metformin [CA = metformin hydrochloride]
4. Tenormin [CA = atenolol]
,Van Leeuwen: Davis's Comprehensive Manual Lab & Dx Tests 11e 3
Test Bank - Circulatory System
12. Which dietary instruction should a nurse plan for a patient who has a triglyceride level of 300
milligrams per deciliter (SI = 3.4 millimoles per liter)?
1. “Avoid monounsaturated and polyunsaturated fats.”
2. “Decrease intake of omega-3 fatty acids, such as those found in fish.”
3. “Eliminate all dairy products.”
4. “Reduce or avoid intake of alcoholic beverages.”
13. A young woman with a significant family history of coronary artery disease is planning to
become pregnant in the next year. Prenatal screening results show a homocysteine level of 36
micromoles per liter. What should the nurse teach the patient?
1. Take folic acid and vitamins B6 and B12 daily.
2. Decrease intake of calcium and monounsaturated fats.
3. Increase fluid intake and take an aspirin daily.
4. Schedule monthly injections of B12 and iron.
14. Laboratory results indicate that a patient’s anion gap is 20 millimoles per liter. Which
condition should the nurse plan to manage?
1. Appendicitis
2. Metabolic acidosis
3. Myocardial infarction
4. Pulmonary embolism
15. A mother brings her infant to the emergency department reporting that the infant had a seizure.
While taking the health history, a nurse learns that the mother has been short of money and
has been diluting the infant’s formula with more water than the instructions recommend.
Based on this information, which laboratory result should the nurse anticipate?
1. Blood glucose 102 milligrams per deciliter (SI = 5.7 millimoles per liter)
2. Chloride 104 milliequivalents per liter (SI = 104 millimoles per liter)
3. Potassium 4.1 milliequivalents per liter (SI = 4.1 millimoles per liter)
4. Sodium 125 milliequivalents per liter (SI = 125 millimoles per liter)
16. A patient is admitted to the hospital with a diagnosis of confusion. The patient has a serum
digoxin level of 3.2 nanograms per milliliter (SI = 4.1 nanomoles per liter). Which additional
laboratory data should the nurse monitor?
1. BUN level
2. Serum potassium level
3. Hematocrit level
4. Serum sodium level
17. A postoperative patient who has not had oral intake for several days and is receiving D5W at
125 milliliters per hour reports nausea and new onset of a persistent headache. Which
laboratory value should the nurse identify as the cause for this clinical presentation?
1. Creatinine 1.1 milligrams per deciliter (SI = 97.2 micromoles per liter)
,Van Leeuwen: Davis's Comprehensive Manual Lab & Dx Tests 11e 4
Test Bank - Circulatory System
2. Serum potassium 5.2 milliequivalents per liter (SI = 5.2 millimoles per liter)
3. Serum sodium 125 milliequivalents per liter (SI = 125 millimoles per liter)
4. Urine sodium 122 milliequivalents per 24 hours (SI = 122 millimoles per liter)
18. The nurse should assess for hypomagnesemia in which patient?
1. A patient with a history of chronic alcoholism
2. A patient with hyperkalemia
3. A patient who ingested antacids containing magnesium
4. A patient who maintains a vegetarian diet
19. A patient has orders for serial troponin levels on admission and then every 6 hours times three.
The initial troponin level is 8 nanograms per milliliter, and 6 hours later the troponin level is
168 nanograms per milliliter. Based on this result, the nurse should plan care for which
diagnosis?
1. Acute myocardial infarction (MI)
2. Pulmonary embolism (PE)
3. Chronic obstructive pulmonary disease (COPD)
4. Deep vein thrombosis (DVT)
20. A nurse is collecting an arterial blood sample for a lactic acid level. Which action should the
nurse take to ensure that the specimen provides an accurate result?
1. Assist the patient to ambulate immediately prior to collecting the specimen.
2. Ensure that the specimen is mixed well by agitating the tube at least 30 seconds.
3. Remove oxygen for at least 10 minutes before obtaining the specimen.
4. Place the specimen on ice and transport to the laboratory immediately.
21. An adolescent patient is brought to an urgent care center with reports of increasing weakness
and persistent vomiting for 3 days. Which finding in a blood gas analysis should the nurse
expect?
1. pH 7.32; PCO2 50 millimeters of mercury (SI = 50 kPa); HCO3 20 millimoles per liter
2. pH 7.4; PCO2 40 millimeters of mercury (SI = 40 kPa); HCO3 23 millimoles per liter
3. pH 7.47; PCO2 44 millimeters of mercury (SI = 44 kPa); HCO3 30 millimoles per liter
4. pH 7.6; PCO2 30 millimeters of mercury (SI = 30 kPa); HCO3 24 millimoles per liter
22. A nurse is preparing to draw an arterial sample for blood gas analysis. Which equipment
should the nurse have available?
1. High-flow oxygen facemask
2. Ice slurry in a cup or plastic bag
3. Tourniquet
4. Red-topped Vacutainer tube
,Van Leeuwen: Davis's Comprehensive Manual Lab & Dx Tests 11e 5
Test Bank - Circulatory System
23. A nurse is attempting to insert a needle to obtain a blood specimen, but the patient is exhibiting
signs of a vasovagal reaction. Which problem should the nurse be most concerned about?
1. Fear related to venipuncture
2. Potential for a fall injury
3. Pain related to venipuncture
4. Risk for impaired skin integrity
24. A patient has had a myocardial infarction and needs to undergo testing to evaluate the damage
to the myocardium. Which test would be appropriate for this purpose?
1. Thyroxine, free
2. Triiodothyronine, free
3. Thyroid-stimulating hormone (TSH)
4. Troponins I and T
25. An 80-year-old patient has a carotid ultrasound that shows stenosis of 40% to 60% and a
moderate amount of plaque. Which nursing action is appropriate for this patient?
1. Advise the patient that surgery is indicated as soon as possible.
2. Avoid use of aspirin or products containing aspirin.
3. Instruct the patient to report any changes in speech, balance, or vision.
4. Recommend that the patient restrict activity until medication decreases the stenosis.
26. When collecting any specimen for laboratory analysis, which is the priority action by the
nurse?
1. Communicating with the patient about the prescribed laboratory test
2. Identifying the patient with the health-care facility’s two person-specific identifiers
3. Informing the patient about the purpose of the specimen collection
4. Labeling the specimen with the patient’s name, room number, or address
27. A patient with persistent pleural edema is scheduled for magnetic resonance imaging (MRI)
of the chest. Which information in the patient’s medical history should the nurse identify as
a contraindication for this procedure?
1. Allergy to shellfish
2. Implanted cardiac pacemaker
3. Bilateral breast implants
4. Tattoo on a lower extremity
28. A nurse is collecting blood from a patient for a B-type natriuretic peptide test. This test will
assist in diagnosing which condition?
1. Heart failure
2. Stroke
3. Leukemia
4. Chronic obstructive pulmonary disease (COPD)
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29. During collection of a venous blood sample, a nurse finds it difficult to locate a patient’s vein
while wearing gloves. Which action by the nurse is appropriate?
1. Identify landmarks where the vein is palpable and attempt venipuncture with gloves on.
2. Obtain assistance from another nurse to perform venipuncture.
3. Remove one glove from the dominant hand to palpate the vein.
4. Tear off two fingertips from the glove to make them accessible for palpation.
30. A nurse is preparing to perform venipuncture on a 6-month-old infant with anemia. The infant
has had multiple specimens drawn over an extended hospitalization. The mother is very
anxious and tells the nurse that she does not want any more blood drawn because it is too
upsetting. Which response by the nurse is most appropriate?
1. “I am sure you think this is best for your child, but you are interfering with treatment by
refusing this test.”
2. “If you are sure you do not want the test done, I will call your health-care provider to get
it cancelled. It is up to you.”
3. “Your health-care provider ordered this test, so I am sure you want to have it done or your
health-care provider will not be able to do what is best for your child.”
4. “We all want what is best for your child. Tell me more about why you are upset now.”
31. A patient admitted to an emergency department with trauma after a motorcycle accident needs
blood drawn. The patient has a fracture of the right arm that is splinted, lacerations of both
legs, and IV fluids infusing in the left antecubital space. Which intervention is most
appropriate for the nurse to collect the required blood specimens?
1. Access a vein in the foot for specimen collection.
2. Request insertion of a central line to use for blood collection and IV access as needed.
3. Stop the IV infusion for 2 minutes and then access a site below the IV.
4. Use a butterfly needle to access a vein in the right hand.
32. The nurse recognizes that which patient should have a computed tomography (CT) scan for
cardiac scoring?
1. 30-year-old-female, overweight, high-stress occupation, total cholesterol 110 milligrams
per deciliter (SI = 2.8 millimoles per liter)
2. 45-year-old male, type 2 diabetes, sedentary lifestyle, high-density lipoprotein (HDL)
cholesterol 35 milligrams per deciliter (SI = 0.9 millimoles per liter)
3. 60-year-old female with no family history of heart disease, active lifestyle, nonsmoker
4. 70-year-old male, participates in senior triathlons, body mass index (BMI) 21.2, history
of hypertension
33. Which statement or question by a nurse will ensure that a specimen is obtained from the
correct patient?
1. “Are you [state patient’s full name]?”
2. “I am comparing the name on your armband with this lab requisition form.”
3. “Please state your full name and birth date.”
4. “What test did your health-care provider order for you?”
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34. A patient with a family history of early-onset coronary artery disease is tested for
apolipoprotein A and B (apo A and apo B). The patient has concerns about the need for another
blood test. Which is the best response by the nurse when the patient asks about the purpose of
the apolipoprotein test?
1. “A high apolipoprotein level means that you are more likely to respond to diet changes
and medications to control your cholesterol.”
2. “As long as you do not have symptoms, this test is just a way to monitor your overall
health, so you should not worry about it.”
3. “Knowing your apolipoprotein helps your health-care provider better determine your risk
for coronary artery disease when you have a high triglyceride level.”
4. “This is just one more test that your health-care provider wants, so you should do it
because it could be important.”
35. Which observation by a nurse indicates that a scheduled venous Doppler study is
contraindicated for this patient?
1. Contact isolation
2. Receiving patient-controlled analgesia (PCA) for chronic back pain
3. Restless, confused, and needs frequent reminders to remain in bed
4. Venous stasis ulcer on both lower extremities
36. A nurse is preparing to collect a blood specimen from an 8-year-old patient who requires
frequent venipuncture related to a chronic illness. The patient is anxious and pulls his arm
away as the nurse begins the prep for the procedure. Which action by the nurse is most
appropriate?
1. Apply a topical anesthetic such as EMLA and reassure the patient that the venipuncture
will not hurt.
2. Ask the child’s parent to restrain the patient during the procedure.
3. Involve the child in the procedure by asking him to help by holding the gauze and bandage
to use after the specimen is collected.
4. Request assistance from another staff member to restrain the patient.
37. A nurse is collecting a capillary specimen for blood glucose from a patient on an insulin drip
to treat postoperative hyperglycemia. The patient reports pain from the multiple, hourly
fingersticks required by the intensive insulin protocol. Which action by the nurse is
appropriate?
1. Decrease the frequency of the fingerstick to every other hour.
2. Alternate sites by using the great toe on either foot instead of the fingers.
3. Use the earlobe or forearm as alternate sites.
4. Ensure that the puncture is not on the finger pad and avoid bruised areas.
38. A patient who recently completed a multigated acquisition (MUGA) scan asks what it means
that the test showed an ejection fraction of 65%. Which answer by the nurse is accurate?
1. “This scan shows that your heart was affected by a heart attack at some point, because
your ejection fraction is below average.”
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2. “The ejection fraction shows the effectiveness of the pumping function of the ventricles.
A normal ejection fraction is 55% to 70%.”
3. “Because the ejection fraction is so low, these results indicate that your heart does not
pump as effectively as it should when you are exercising.”
4. “Your health-care provider will follow up with you, but your results will require treatment
because your ejection fraction was so high.”
39. A nurse is collecting blood specimens from an older adult patient with small veins that
collapse or disappear when the nurse tries to insert the needle. The patient has IV fluids
infusing through a peripherally inserted central catheter (PICC) in the left antecubital area.
After two attempts in the right antecubital space using a Vacutainer, the nurse is unable to
obtain the required specimens. Which action is appropriate for the nurse to take next?
1. Attempt again using a syringe attached to a butterfly needle.
2. Confirm the institutional policy regarding the use of a PICC for specimen collection.
3. Request assistance from another nurse to attempt venipuncture again.
4. Use a 5-milliliters syringe to withdraw a sample from the Y-port closest to the patient’s
PICC insertion point.
40. A patient admitted with a fever of unknown origin has orders for “blood cultures ´ 3.” The
nurse should inform the patient that this procedure involves which of the following?
1. Collecting three samples daily in the morning, with one venipuncture when other daily
blood work is obtained
2. Obtaining three samples from different sites, with each sample requiring venipuncture
3. Obtaining sufficient blood to prepare three sets of culture vials with one venipuncture
4. Using random specimens, collected at the time other blood samples are obtained, to
minimize the number of venipunctures required
41. A nurse is preparing to draw blood from a patient who is hearing impaired. Which action by
the nurse is most appropriate?
1. Ask a family member whether the patient will cooperate with the procedure.
2. Discuss the procedure and the patient’s preferences with a family member who is
proficient in sign language before beginning the procedure.
3. Face the patient while explaining the procedure to a qualified sign language interpreter
provided by the facility.
4. Provide written information and use a whiteboard so the patient can communicate without
violating the patient’s privacy.
42. A patient diagnosed with heart failure has a B-type natriuretic peptide (BNP) level of 945
picograms per milliliter (SI = 945 nanograms per liter) upon admission to the hospital. At
discharge, the patient’s BNP is 435 picograms per milliliter (SI = 435 nanograms per liter).
Which discharge instruction is most important for the nurse to share with the patient?
1. “Have additional pillows available in case you have increased dyspnea at night.”
2. “Maintain bedrest if there is any edema of the ankles or feet.”
3. “Monitor weight daily and report weight gain immediately to the health-care provider.”
