NCLEX-RN: Taking a Patient for Tests and Therapy

Patients undergoing tests and therapy require nursing care during and after their procedures. For the NCLEX-RN exam, you need to know what’s necessary to maintain patient safety during the medical test and physiological integrity after the therapy or procedure.

Facing an MRI, the hot potato of medical tests

When you think of having an MRI, what’s the first thing that comes to mind? If you thought “claustrophobia,” you’re on the same wavelength as many of your future patients. Many patients have a fear of being enclosed in an MRI, but claustrophobia isn’t the only thing that can cause chaos in an MRI. Magnetic resonance imaging (MRI) uses magnetic and radio waves to create a detailed visualization of the brain, heart, and other body structures. Pacemakers and surgical or orthopedic clips can wreak havoc with the patient — and the equipment. (Shrapnel shouldn’t be scanned, either, so be sure that you have a complete history!) Always remove jewelry and metal objects from the patient prior to the procedure, and always determine the patient’s ability to lie still and the possibility that he or she may become claustrophobic.

Here’s an example of questions related to patient tests:

Practice question

A client is scheduled for magnetic resonance imaging (MRI) of the head. Which of the following areas is essential to assess before the procedure?

(1) Food and drink intake within the past eight hours

(2) The presence of metal fillings, prosthesis, or a pacemaker

(3) The presence of carotid artery disease

(4) Voiding before the procedure

Keywords for this question are MRI of the head and essential to assess before the procedure. The correct answer is Choice (2). Strong magnetic waves may dislodge metal in the client’s body, possibly causing injury. Although the client may be told to restrict food intake for eight hours prior to the procedure, particularly if contrast will be used, metal is an absolute contraindication for this procedure because it’s a safety issue. Voiding beforehand makes the client more comfortable and better able to remain still during the procedure, but it isn’t essential for the test. And carotid artery disease isn’t a contraindication.

Handling therapies, from dialysis to radiation

There’s no end to therapy when you’re a nurse. Types of therapy include chemotherapy, radiation, physical and occupational therapy, respiratory therapy, dialysis, and dozens of others. Every type of therapy has both an expected and unexpected outcome; you need to be aware of both the potential positive and negative outcomes so that you know what to look for when administering therapy to a patient. You also have to know the what, why, and how of therapy: What is this therapy expected to do for this patient? Why does the patient need it? What’s gone wrong that needs to be corrected? And how does this therapy accomplish that?

Questions on therapies usually focus on radiation and chemotherapy. Tuck away the following facts, and you’ll be well prepared for these types of questions:

• When it comes to radiation:
  • Side effects are cumulative. The effects appear after the total dose exceeds the body’s ability to repair damage caused by radiation.
  • Fatigue is one of the most common side effects of radiation and often isn’t relieved by rest.
  • Other side effects of radiation include skin problems, anorexia, nausea, vomiting, diarrhea, anemia, leucopenia, and thrombocytopenia.
  • Physical therapy can be draining for the patient, and interventions are coordinated as necessary around patient needs.
• When it comes to chemotherapy:
  • Chemo is a balancing act based on the ability of a drug to kill cancer cells while damaging normal cells as little as possible.
  • The destruction of normal cells leads to numerous side effects that affect body systems, including but not limited to GI, hematologic, integumentary, renal, reproductive, and neurologic systems.
  • The effect of chemotherapy is greatest on rapidly dividing cells, such as bone marrow cells, GI tract, and hair.

Other therapies, such as wound therapy, may show up in questions related to pressure ulcers and nursing management. You can also expect questions on cardiovascular disorder interventions such as percutaneous transluminal coronary angioplasty (PTCA), coronary artery stents, atherectomy, coronary artery bypass graft (CABG), and cardiac transplant. I simply don’t have the space to list all the main facts about all these therapies, so refer to your textbooks for a refresher.

The following are some examples of questions related to patient therapy:

Practice question

The client is undergoing radiation therapy to treat lung cancer. Following the treatment, the nurse notes erythema on the client’s chest and neck, and the client is complaining of pain at the radiation site. The nurse interprets this data to mean

(1) A superficial injury to the tissue from the radiation

(2) An allergic reaction to the radiation

(3) A cutaneous reaction to products formed by the lysis of the neoplastic cells

(4) An ischemic injury, much like decubitus formation, caused by pressure from the machine

Keywords for this question are undergoing radiation therapy, treat lung cancer, erythema on the client’s chest and neck, complaining of pain at the radiation site, and nurse interprets. The correct answer is Choice (1). Superficial injury from radiation can manifest with erythema, hyperpigmentation, dry desquamation, or moist desquamation. Moist desquamation is comparable to a second-degree burn in histology, appearance, and sensation. Note the relationship between erythema in the question and the reference to superficial injury in the correct response.

Practice question

A nurse is evaluating a client’s response to cardioversion. Which of the following observations would be of the highest priority to the nurse?

(1) Oxygen flow rate

(2) Status of the airway

(3) Blood pressure

(4) Level of consciousness

Keywords in this question are evaluating the client’s response to cardioversion, observations, and the highest priority to the nurse. The correct answer is Choice (2). Nursing responsibility after cardioversion is the maintaining the airway first, followed by administering oxygen and assessing vital signs and level of consciousness. Noting the key phrase “highest priority” prompts you to refer to the ABCs and use the process of elimination to reach the correct answer.

Practice question

A client is admitted to the emergency department with an active diagnosis of acute myocardial infarction. The patient is started on tissue plasminogen activator (tPA) by infusion. Which of the following parameters would a nurse determine requires the least frequent assessment to detect complications of therapy with tPA?

(1) Oxygen saturation

(2) Neurological signs

(3) Blood pressure and pulse

(4) Complaints of abdominal and back pain

Keywords in this question are an active diagnosis of acute myocardial infarction, tissue plasminogen activator, which of the following parameters requires the least frequent assessment, and detect complications of therapy. The correct answer is Choice (1). An acute myocardial infarction is due to a clot or plaque blockage, and the drug is given to break up clots. So your priority is bleeding. The key phrase here is least frequent assessment. Thrombolytic agents dissolve clots, and bleeding can occur anywhere in the body. The nurse monitors for any signs of bleeding and also for occult (hidden) signs of bleeding by taking hemoglobin and hematocrit values, blood pressure, and pulse; checking neurological signs; assessing abdominal and back pain; and checking for the presence of blood in the stool and/or urine. Bleeding is the primary complication of thrombolytic therapy.

The preceding question requires you to set priorities. A change in neurological signs can indicate cerebral bleeding, abdominal and back pain can indicate abdominal bleeding, and change in blood pressure and pulse can be general indicators of hemorrhage. Oxygen saturation isn’t an indicator of bleeding in the respiratory tract.

Practice question

A client has moist saline dressings applied to an open ulcer of the foot. Ten days after ulcer development, the wound should have which appearance?

(1) Red, swollen tissue

(2) Dry, crusted scab

(3) Deep, wide keloid

(4) Warm, painful tissue

Keywords for this question are moist saline dressings, open ulcer of the foot, ten days after ulcer development, and should have which appearance. The correct answer is Choice (2). Ten days into healing, an ulcer should be at the end of the lag phase of healing, as indicated by a dry, crusted scab. The tissue is red, swollen, warm, or painful during the inflammatory period, which occurs two to seven days after the ulcer develops. A deep, wide keloid may appear three weeks to two years after ulcer development.

Practice question

Which of the following treatments is a suitable surgical intervention for unstable angina?

(1) Cardiac catheterization

(2) Echocardiogram

(3) Nitroglycerin

(4) Percutaneous transluminal coronary angioplasty (PTCA)

The keywords for this question are suitable surgical intervention and unstable angina. The correct answer is Choice (4). Angina is caused by a blockage, so look for an answer choice that would open the blockage. PTCA can alleviate the blockage and restore blood flow and oxygenation. An echocardiogram is a noninvasive diagnostic test. Nitroglycerin is an oral or sublingual medication. Cardiac catheterization is a diagnostic tool, not a treatment.

Practice question

A client has been to hemodialysis. Which of the following should the nurse be alert to for complications? Select all that apply.

(1) Fluid volume excess

(2) Disequilibrium

(3) Hemorrhage

(4) Shock

(5) Air emboli

Keywords for this question are has been to hemodialysis and alert to for complication. The correct answers are Choices (2), (3), (4), and (5). Disequilibrium, hemorrhage, shock, and air emboli are all complications of hemodialysis. Hemodialysis takes fluid off, so Choice (1) is incorrect.