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Diagnostic Tests

NCLEX Review Guide: Adult Health - Respiratory Diagnostic Tests

Pulmonary Function Tests (PFTs)

Spirometry

  • Forced Vital Capacity (FVC) measures the maximum amount of air expelled after maximum inspiration, normally 4000-5000 mL in healthy adults.
  • Forced Expiratory Volume in 1 second (FEV1) evaluates airway obstruction and should be >80% of FVC in normal individuals.
  • FEV1/FVC ratio <70% indicates obstructive disease like asthma or COPD, while reduced FVC with normal ratio suggests restrictive disease.

Key Points

  • Patient must avoid bronchodilators 4-6 hours before test
  • Requires patient cooperation and ability to follow instructions
  • Contraindicated in recent MI, eye surgery, or pneumothorax

Arterial Blood Gas (ABG) Analysis

Normal Values & Interpretation

  • pH 7.35-7.45 indicates acid-base balance, with <7.35 being acidic and >7.45 being alkalotic.
  • PaCO2 35-45 mmHg reflects respiratory function and CO2 elimination by the lungs.
  • HCO3- 22-26 mEq/L represents metabolic component and kidney's ability to regulate bicarbonate.
  • PaO2 80-100 mmHg measures oxygen dissolved in arterial blood and indicates oxygenation status.

Memory Aid: ROME

Respiratory Opposite - pH and CO2 move in opposite directions
Metabolic Equal - pH and HCO3 move in same direction

Clinical Scenario

Patient with COPD exacerbation: pH 7.32, PaCO2 58, HCO3- 28
Interpretation: Respiratory acidosis with partial metabolic compensation

Key Points

  • Apply pressure to puncture site for 5-10 minutes after arterial puncture
  • Place sample on ice and transport immediately to lab
  • Check circulation distal to puncture site

Chest X-Ray Interpretation

Normal Findings & Abnormalities

  • Posterior-anterior (PA) view is standard with patient standing upright and chest against film plate for optimal visualization.
  • Consolidation appears as white/opaque areas indicating fluid, pus, or solid material in alveoli, commonly seen in pneumonia.
  • Pneumothorax shows as dark area without lung markings, with possible mediastinal shift in tension pneumothorax.
Important Alert: Always check for tracheal deviation and mediastinal shift - indicates tension pneumothorax requiring immediate intervention!

Key Points

  • Remove all metal objects before X-ray
  • Pregnant women require lead apron protection
  • Portable chest X-rays are less detailed than department films

Advanced Respiratory Diagnostics

Bronchoscopy

  1. Obtain informed consent and ensure NPO status 6-12 hours before procedure
  2. Administer pre-procedure sedation and topical anesthesia to throat and airways
  3. Monitor vital signs, oxygen saturation, and cardiac rhythm during procedure
  4. Post-procedure: Keep NPO until gag reflex returns (2-4 hours)
Post-bronchoscopy: Monitor for hemoptysis, pneumothorax, and respiratory distress. Report fever >101°F or persistent bleeding immediately.

CT Pulmonary Angiogram (CTPA)

  • Gold standard for diagnosing pulmonary embolism with contrast dye injection to visualize pulmonary vessels.
  • Requires IV access for contrast administration and assessment of kidney function (creatinine, BUN) before procedure.

Key Points

  • Check for contrast allergies and shellfish/iodine sensitivity
  • Ensure adequate hydration before and after contrast studies
  • Monitor for contrast-induced nephropathy in high-risk patients

Commonly Confused Concepts

Restrictive vs. Obstructive Disease

CharacteristicRestrictiveObstructive
FVCDecreasedNormal or decreased
FEV1DecreasedSignificantly decreased
FEV1/FVC RatioNormal (>70%)Decreased (<70%)
ExamplesPulmonary fibrosis, chest wall deformityAsthma, COPD, bronchiectasis

Memory Aid: ABG Compensation

Acute: No compensation (normal HCO3 or CO2)
Partial: pH still abnormal but moving toward normal
Complete: pH normal but CO2 and HCO3 both abnormal

Study Tips & Quick Checks

Self-Assessment Checklist

  • ☐ Can I interpret basic ABG values and identify acid-base disorders?
  • ☐ Do I understand the difference between oxygenation (PaO2) and ventilation (PaCO2)?
  • ☐ Can I identify key nursing considerations for each diagnostic test?
  • ☐ Do I know the contraindications for pulmonary function tests?
  • ☐ Can I recognize signs of complications post-bronchoscopy?

Quick Reference: Normal ABG Values

pH: 7.35-7.45
PaCO2: 35-45 mmHg
HCO3-: 22-26 mEq/L
PaO2: 80-100 mmHg

Common Pitfalls

  • Don't confuse oxygenation with ventilation - PaO2 measures oxygen, PaCO2 measures carbon dioxide elimination
  • Remember post-procedure care - bronchoscopy patients need NPO until gag reflex returns
  • Always assess for contrast allergies before CT with contrast or pulmonary angiography

Remember: You've got this! Respiratory diagnostics may seem complex, but with practice and understanding of the key concepts, you'll master these questions. Focus on understanding the why behind each test and its nursing implications. Your dedication to learning will make you an excellent nurse!

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