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Copyright © 2019, Elsevier Inc. All Rights Reserved.

Pagana: Mosby’s Canadian Manual of Diagnostic and Laboratory

Tests, 2nd Canadian Edition

Review Questions

Cancer

1. Question: A 36-year-old patient indicates that she wants both of her breasts removed

because of a strong family history of breast cancer. Her mother developed breast

cancer at age 45 and died of that disease at age 50. Her older sister is now dying of

breast cancer at age 44. The patient has two young daughters and does not want to

risk dying before her children grow up. What advice should the nurse give her?

2. Question: A 48-year-old patient is concerned about the radiation exposure risk

associated with mammography. She would like to undergo breast scintigraphy

instead. What advice should the nurse give her?

3. Question: During a routine evaluation, a patient is found to have a suspect lesion on

mammography. Her physical examination results are negative, and she has no

palpable masses. Should a biopsy of this mass be performed?

4. Question: The patient is a 56-year-old woman who had a colon cancer removed 2

years ago. Her carcinoembryonic antigen (CEA) level is now 4.2 mcg/L. Is this

significant?

5. Question: A 62-year-old patient is admitted to the hospital for melanoma. During his

staging workup, a bone scan is performed. The bone scan is normal except for a “hot

spot” in the right rib. What might have caused this abnormality?

6. Question: A 22-year-old female patient complains of right upper quadrant abdominal

pain. Gallbladder ultrasonography and upper gastrointestinal endoscopy are

performed, and the results are negative. A liver-spleen scan indicates a filling defect

in the anterior surface of the liver. Does this indicate a liver tumour?

7. Question: A patient with a diagnosis of pancreatic cancer has recently been admitted

to the hospital with a rapid onset of ascites. She is extremely uncomfortable and

anxious to institute treatment for this symptom. The nurse is aware that the CA 19-9

tumour marker tests have been performed. What is the purpose of the CA 19-9

marker and how could it influence care?

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Pagana: Mosby’s Canadian Manual of Diagnostic and Laboratory

Tests, 2nd Canadian Edition

Review Questions Answer Key

Cancer

1. Question: A 36-year-old patient indicates that she wants both of her breasts removed

because of a strong family history of breast cancer. Her mother developed breast

cancer at age 45 and died of that disease at age 50. Her older sister is now dying of

breast cancer at age 44. The patient has two young daughters and does not want to

risk dying before her children grow up. What advice should the nurse give her?

Answer: This woman does have a significant family history of breast cancer and may

have a breast cancer antigen (BRCA) genetic defect. If appropriate, the nurse should

provide information on how the patient and her sister could be tested for the BRCA

gene. If the test is positive, further genetic consultation is required. It is important to

inform the BRCA-negative patient that her risk is still similar to that of the general

public.

Reference page: 1140

2. Question: A 48-year-old patient is concerned about the radiation exposure risk

associated with mammography. She would like to undergo breast scintigraphy

instead. What advice should the nurse give her?

Answer: Mammography is an X-ray examination of the breast that is performed with

exposure to approximately 0.5 rad of radiation per view. Scintigraphy involves an

injection of an intravenous radionuclide and the use of a gamma ray scintigraphy

camera to pass over the breasts and record radioactive uptake or “hot” or “cold”

spots. Because the amount of radionuclide used in scintigraphy is small, there is a

relatively low risk of radiation exposure; however, mammography has an even lower

risk of radiation exposure than scintigraphy.


3. Question: During a routine evaluation, a patient is found to have a suspect lesion on

mammography. Her physical examination results are negative, and she has no

palpable masses. Should a biopsy of this mass be performed?

Answer: Mammography can be used to locate a mammographically identified (i.e.,

not palpable) lesion for biopsy, but follow up is required. It is important to inform the

patient that further testing is not uncommon after a mammograph. If the radiologist

sees something that should be more thoroughly evaluated with magnified views,

deeper views, or ultrasonography, the patient may be called back for further testing,

prior to performing a biopsy.


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4. Question: The patient is a 56-year-old woman who had a colon cancer removed 2

years ago. Her carcinoembryonic antigen (CEA) level is now 4.2 mcg/L. Is this

significant?

Answer: This patient’s CEA level is elevated, but not above normal. This test is used

in the surveillance of patients with cancer. A steadily rising CEA level is occasionally

the first sign of tumour recurrence. Therefore, CEA testing is very valuable in the

follow-up of patients who have already had potentially curative therapy. However,

many (∼20%) patients with advanced breast or gastrointestinal tumours may not have

elevated CEA levels. Without knowing this patient’s prior CEA levels, it is not

certain that the level represents recurrent disease. However, if continued monitoring

reveals a rising CEA level on successive tests, it may be indicative of cancer

recurring in this patient.

Reference page: 160

5. Question: A 62-year-old patient is admitted to the hospital for melanoma. During his

staging workup, a bone scan is performed. The bone scan is normal except for a “hot

spot” in the right rib. What might have caused this abnormality?

Answer: Increased uptake on a bone scan, or hot spots, may indicate areas of

osteoblastic or new bone growth around areas, or abnormality such as a tumour,

arthritis, or injury. Hot spots can be caused by many factors including tumour

metastatic to the bone, an old healed fracture, arthritis, or benign bone disease. In this

case, radiography of the rib was performed, and an old healed rib fracture was

identified. According to a more accurate history from the patient, he had fallen

several years ago and had severe pain in that area for more than 2 weeks. This history

is compatible with a previous fracture of the rib.

Reference page: 810

6. Question: A 22-year-old female patient complains of right upper quadrant abdominal

pain. Gallbladder ultrasonography and upper gastrointestinal endoscopy are

performed, and the results are negative. A liver-spleen scan indicates a filling defect

in the anterior surface of the liver. Does this indicate a liver tumour?

Answer: No. Many diseases can produce an abnormal liver scan such as this. Benign

tumours (e.g., adenomas, cysts, congenital abnormalities) can cause such an

appearance. Computed tomography should be performed to eliminate the possibility

of a cyst. CT-guided liver biopsies also can be performed to elucidate more clearly

the cause of this abnormal liver scan. If these procedures fail to resolve the problem,

peritoneoscopy with actual visualization of that portion of the liver can be performed.

Reference page: 836

7. Question: A patient with a diagnosis of pancreatic cancer has recently been admitted

to the hospital with a rapid onset of ascites. She is extremely uncomfortable and

anxious to institute treatment for this symptom. The nurse is aware that the CA 19-9

tumour marker tests have been performed. What is the purpose of the CA 19-9

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marker and how could it influence care?

Answer: CA 19-9 antigen is a tumour marker used for the diagnosis of pancreatic or

hepatobiliary cancer, evaluation of response to treatment, and surveillance. If the CA

19-9 level is greatly elevated in this patient, it could indicate the presence of a

pancreatic mass or biliary obstruction which would help to explain the ascites. A

rapid rise in CA 19-9 levels could also be associated with recurrent or progressive

tumour growth resulting in a shift of fluids and abdominal ascites. The CA 19-9

marker could help to determine the cause of the ascites and thus influence medical or

surgical care.

Reference page: 145

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Copyright © 2013 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

Pagana: Mosby's Canadian Manual of Diagnostic and Laboratory Tests,

1st Canadian Edition

Practice Test

1. Which of these instructions should a nurse give an elderly, dehydrated patient after

computed tomography (CT) of the kidney with intravenous iodine contrast material?

a. Drink plenty of fluids for 24 hours.

b. Avoid heavy lifting for 2 days.

c. Use a laxative to clear the contrast from the bowel.

d. None of the above.

2. For a patient with severe bone destruction from tumour or osteomalacia, what serum

laboratory results would the nurse expect to assess?

a. Decreased serum alkaline phosphatase (ALP) level

b. Increased serum ALP level

c. Decreased erythrocyte sedimentation rate

d. Increased red blood cell count

3. A patient’s laboratory reports indicate the presence of Bence-Jones proteins. These levels

are increased in the urine of patients who have:

a. Multiple myeloma

b. Carcinoid syndrome

c. Breast cancer

d. Colorectal cancer

4. A patient is admitted for evaluation of perforated diverticulitis. Which of the following is

the most appropriate test?

a. CT of the abdomen

b. Barium enema

c. Colonoscopy

d. All the above

5. Blood urea nitrogen (BUN) levels may be abnormally low in which patients?

a. Overly hydrated patients

b. Patients with liver disease

c. Malnourished patients in negative nitrogen balance

d. All the above

6. The serum creatinine level is usually elevated in patients with which of the following?

a. Renal disease

b. Liver disease

c. Lung disease

d. Muscular disease

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Practice Test 2


7. A patient presents with upper gastrointestinal bleeding from a suspected peptic ulcer.

Which of the following is the most appropriate test?

a. Upper gastrointestinal radiography

b. Gastric bleeding scan

c. Esophagogastroduodenoscopy (EGD)

d. None of the above

8. A patient is admitted with abdominal pain. Ultrasonography of the abdomen, CT of the

abdomen, and a barium enema study have been ordered. In what order should these tests

be performed?

a. Ultrasonography, barium enema, CT

b. Ultrasonography, CT, barium enema

c. Barium enema, CT, ultrasonography

d. CT, barium enema, ultrasonography

9. A patient is scheduled for a cardiac exercise stress test to evaluate chest pain. While

obtaining the patient history, the clinician notes that the patient has intermittent

claudication when walking two blocks. On the basis of this finding, which of the

following is indicated?

a. The test will be performed as scheduled.

b. The test is contraindicated because of the intermittent claudication.

c. The test will be rescheduled after resolution of the claudication.

d. The patient is a candidate for the dipyridamole-thallium (nonexercise) stress test.

10. A patient is scheduled for a cardiac catheterization. Which of the following activities is a

postprocedure nursing priority?

a. Ambulating the patient

b. Encouraging coughing and deep-breathing exercises

c. Keeping the patient on NPO status (nothing by mouth)

d. Keeping the involved extremity immobilized

11. One of the blood studies used to detect a myocardial infarction is creatine kinase (CK).

What value is most helpful for diagnosing a myocardial infarction?

a. Total CK

b. Isoenzyme CK-MM

c. Isoenzyme CK-MB

d. Isoenzyme CK-BB

12. During a patient’s exercise stress test, his blood pressure dropped. Which of the

following activities should be avoided in the 2-hour period after the test?

a. Walking

b. Taking a hot shower

c. Eating a light meal

d. Resting in his bed

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Practice Test 3


13. A patient had a lipid profile documented and asks about her results. Which of the

following is considered the ideal high-density lipoprotein (HDL)/total cholesterol ratio?

a. 1:2

b. 1:3

c. 1:4

d. 1:5

14. A patient underwent a tuberculin skin test 48 hours ago. He returns to the clinic for the

nurse to read the test results. Which of the following is considered a positive result?

a. A reddened area measuring 20 mm

b. A flat, red area measuring 10 mm

c. An indurated area measuring 8 mm

d. An indurated area measuring 12 mm

15. A patient with diabetes was taken to the emergency department. His arterial blood gas

results were as follows:

pH: 7.25

Partial pressure of carbon dioxide (PCO2): 38 mm Hg

HCO3-: 19 mmol/L

Partial pressure of oxygen (PO2): 95 mm Hg

What do these results indicate?

a. Respiratory acidosis

b. Respiratory alkalosis

c. Metabolic acidosis

d. Metabolic alkalosis

16. A patient has just returned from the endoscopy suite, where he underwent bronchoscopy.

Which of the following is not a nursing priority after the procedure?

a. Observing the sputum for hemorrhage

b. Monitoring the vital signs frequently

c. Observing the patient closely for laryngospasm

d. Encouraging cool fluids to comfort his throat

17. What is the best time of the day for obtaining a sputum specimen?

a. Early morning

b. After breakfast

c. Evening

d. The time does not matter

18. A patient is scheduled for magnetic resonance imaging (MRI). Which of the following

factors is a contraindication to this procedure?

a. Iodine allergy

b. Severe visual impairment

c. Cardiac pacemaker


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Practice Test 4


19. Which of the following activities should be avoided before electroencephalography

(EEG)?

a. Washing the hair the night before the procedure

b. Taking anticonvulsant medications

c. Drinking caffeinated fluids such as regular coffee, tea, or cola


20. After a lumbar puncture, a nursing priority is to prevent a spinal headache. Which of the

following activities is to be avoided?

a. Ambulating the patient in the room

b. Drinking fluids through a straw

c. Keeping the patient on bed rest

d. Keeping the patient’s head flat

21. A patient is scheduled for lumbar puncture. Which of the following conditions is a

contraindication to this procedure?

a. Meningitis

b. Neurosyphilis

c. Multiple sclerosis

d. Increased intracranial pressure (ICP)

22. Which of the following statements regarding a glycosylated hemoglobin test is false?

a. The test provides an accurate long-term index of the patient’s average blood glucose

level.

b. The test aids in determining the duration of hyperglycemia in a patient with newly

diagnosed diabetes.

c. No fasting is required for this test.

d. Short-term physiologic variations (e.g., those caused by food intake, exercise, and

stress) affect the test result.

23. A patient has an elevated glucose level. Which of the following factors in his history may

cause hyperglycemia?

a. Insulinoma

b. Corticosteroid therapy

c. Hypothyroidism

d. Addison’s disease

24. Cortisol levels normally rise and fall during the day. This fluctuation is referred to as the

diurnal variation. At what time of the day are levels the highest?

a. 8 AM

b. Noon

c. 4 PM

d. Midnight

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Practice Test 5


25. Symptoms that may indicate hypocalcemia include which of the following?

a. Nausea, vomiting, and anorexia

b. Polyuria and dehydration

c. Muscle weakness and coma

d. Tetany and carpal pedal spasms

26. A patient has been diagnosed with primary hypothyroidism. Her triiodothyronine (T3)

and thyroxine (T4) levels are decreased. What would a clinician expect the thyroid-

stimulating hormone (TSH) levels to be?

a. Normal

b. Increased

c. Decreased

d. Near zero

27. Often during a fetal nonstress test (fetal activity determination test), fetal activity must be

stimulated. Which of the following stimuli is not part of this test?

a. Rubbing the mother’s abdomen

b. Administering intravenous oxytocin

c. Ringing a bell near the abdomen

d. Compressing the mother’s abdomen

28. Which of the following statements best describes the Sims-Huhner test?

a. This test is an evaluation of the quality of cervical mucus.

b. This test is an examination of cervical mucus for colour, viscosity, and tenacity.

c. This test is an assessment of the number of motile sperm per high-power microscopic

field.

d. This test is an evaluation of the interaction between the sperm and cervical mucus.

29. Which of the following tests is used to screen blood for antibody compatibility before a

blood transfusion?

a. Direct Coombs test

b. Indirect Coombs test

c. Complete blood cell count

d. Serum haptoglobin test

30. Which of the following statements is false with regard to the semen analysis test?

a. A single sperm analysis can be conclusive evidence of male infertility.

b. Men with little or no sperm should be evaluated for pituitary, thyroid, adrenal, or

testicular aberrations.

c. A 2- to 3-day period of sexual abstinence is necessary before collection of the semen

specimen.

d. For best results, a semen sample should be collected in the physician’s office or

laboratory by means of masturbation.

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Practice Test 6


31. Which of the following tests is used to monitor warfarin administration?

a. Activated partial thromboplastin time

b. Platelet count

c. Bleeding time

d. International normalized ratio (INR)

32. Which of the following factors may cause an increase in hematocrit concentration?

a. Hemorrhage

b. Bone marrow failure

c. Pregnancy

d. Dehydration

33. A “shift to the left” in white blood cell production indicates an acute bacterial infection.

Which of the following cells are increased in this situation?

a. Mature neutrophils

b. Monocytes

c. Lymphocytes

d. Band (or stab) cells

34. The physician orders a blood culture for a patient with suspected bacteremia. Which of

the following statements is incorrect with regard to the collection of this specimen?

a. Blood culture specimens should be drawn at the time the patient has a fever or chills.

b. If the patient is receiving antibiotics already, the laboratory should be notified, and

the blood culture specimen should be collected shortly before the next dose of

antibiotic is administered.

c. Two culture specimens should be obtained and from different sites.

d. The culture specimen can be drawn at any time without regard to medications and

vital signs.

35. Which of the following is a possible cause of hyperkalemia?

a. Diarrhea and vomiting

b. Diuretic drug therapy

c. Cushing’s syndrome

d. Acidosis

36. After returning from an esophagogastroduodenoscopy (EGD) and dilation of an

esophageal stricture, a patient began to complain of fever and chest pain. What should the

nurse suspect, and what is the most appropriate action?

a. Myocardial infarction, and obtaining electrocardiography (ECG) immediately

b. Gastroesophageal reflux, and administering an antacid

c. Esophageal perforation, and notifying the physician immediately

d. Dyspepsia from not eating before the procedure, and allowing the patient to eat bland

food

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Practice Test 7


37. After undergoing a barium enema study, what instruction should patients be given?

a. Take an oral laxative to completely evacuate the barium.

b. Try to retain the barium in case additional radiographic studies are needed the same

day or the following day.

c. Await normal bowel function.

d. None of the above.

38. After returning from colonoscopy, a patient complains of increasing abdominal pain.

What is an appropriate nursing intervention?

a. Limiting her diet to clear liquids

b. Assisting her with a warm bath to soothe the anorectal area

c. Administering a gentle enema to assist in evacuation of colon contents and air

d. Administering a laxative to assist in evacuation of excess colon contents

e. None of the above

39. A woman in her first trimester of pregnancy develops pain consistent with gallbladder

disease. What is the most appropriate diagnostic test?

a. Gallbladder ultrasonography

b. Gallbladder radioscintigraphy scan

c. Oral cholecystography

d. Computed tomography

40. After a liver biopsy, the patient should:

a. Ambulate to maintain mobility

b. Lie on the left side

c. Lie on the right side

d. Lie prone

41. A nurse has been stuck by a needle from a patient being treated for hepatitis. What is the

most appropriate action or actions?

a. Immediate enteric and blood product precautions to isolate the involved nurse

b. Immediately obtaining hepatitis viral studies on the affected nurse

c. Hospitalizing the nurse for bed rest

d. All the above

e. None of the above

42. A patient’s leg has become swollen 1 week after arthroscopy. For what should he be

evaluated?

a. Hemarthrosis

b. Joint stiffness after prolonged immobilization

c. Postoperative thrombophlebitis

d. Joint dislocation

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Practice Test 8


43. A 5-year-old patient has fallen and injured her right arm during play therapy. Why does

the physician order radiographs of both arms?

a. The noninjured arm could have been injured in the fall.

b. Fracture lines of long bones in children are difficult to distinguish from normal

growth lines, which make comparison films necessary.

c. The battered child syndrome can be diagnosed by documenting multiple fractures.

d. All the above.

44. A patient has just undergone diagnostic arthroscopy and has mild discomfort. Which of

the following interventions is most appropriate?

a. Ambulating the patient

b. Notifying the physician

c. Administering a mild analgesic (e.g., acetaminophen)

d. Administering an intramuscular narcotic

45. What drug should be discontinued before the serum gastrin level is measured?

a. Hydrochlorothiazide

b. Propranolol (Inderal)

c. Cimetidine (Tagamet)

d. All the above

46. Which of the following instructions should the nurse give a client after an upper

gastrointestinal study?

a. “Expect your stools to be chalky white for at least a day.”

b. “Take a cathartic (such as milk of magnesia).”

c. “Drink plenty of fluids when you get home.”

d. All the above.

47. Which of the following test results would indicate a complication of endoscopic

retrograde cholangiopancreatography (ERCP)?

a. Red blood cells in the urine

b. Elevated serum amylase level

c. Elevated serum calcium level

d. All the above

48. Carcinoembryonic antigen (CEA) is used to monitor patients with what condition?

a. Colon cancer

b. Breast cancer

c. Gastric cancer

d. All the above

49. Specific gravity in the urine is increased in patients with what condition?

a. Dehydration

b. Diabetes insipidus

c. Chronic renal failure

d. All the above

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Practice Test 9


50. Intravenous pyelography (IVP) may be contraindicated in patients with what condition?

a. Shellfish allergy

b. Severe dehydration

c. Renal insufficiency

d. All the above

51. Immediately after undergoing kidney biopsy, a patient notices gross hematuria. What is

the most appropriate nursing intervention?

a. Collecting serial urine specimens

b. Dehydrating the patient to diminish urine output and bleeding

c. Notifying the physician immediately and obtaining a specimen for blood typing and

crossmatching

d. All the above

52. Which of the following foods may interfere with determining the results of urinary

vanillylmandelic acid or catecholamines?

a. Potatoes and red meat

b. Coffee and licorice

c. Beer and salted pretzels

d. All the above

53. A “no added salt” diet is necessary for patients before which of the following studies?

a. Urine specific gravity

b. IVP

c. Plasma renin assay

d. Renal scanning

54. What is the most specific test for identifying recurrent prostate cancer?

a. Prostatic acid phosphatase measurement

b. Prostate-specific antigen (PSA) measurement

c. Digital rectal examination

d. Transrectal ultrasonography

55. A nurse should ask the patient which of the following questions before scheduling IVP?

a. “Are you allergic to shellfish or iodine?”

b. “Have you ever undergone IVP before?”

c. “Are you able to drink a lot of fluids?”

d. All the above

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Practice Test 10


56. Before mammography, which of the following is or are appropriate information to give a

patient?

a. Mammography involves a low dose of radiation and therefore can safely be

performed annually.

b. Mammography can reveal breast cancer 1 to 2 years before a tumour is clinically

palpable.

c. Although mammography is an accurate means of detecting breast cancer, it is only

85% accurate.

d. All the above.

57. What is the most accurate method of screening for breast cancer?

a. MRI of the breast

b. Mammography

c. Ultrasonography of the breast

d. Physical examination

58. Which of the following tumour markers is associated with breast cancer?

a. Alpha-fetoprotein

b. Human chorionic gonadotropin

c. CA–15-3

d. CA-125

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