FISCHBACH'S A MANUAL OF
LABORATORY AND DIAGNOSTIC TESTS.
11TH EDITION
• AUTHOR(S)FRANCES FISCHBACH;
MARGARET FISCHBACH; KATE STOUT
TESTBANKS
Ch. 1 — Diagnostic Testing
Stem: A nurse in the ED receives a blood specimen from a
different unit labeled with the room number but without the
patient’s name or armband verification. The attending requests
stat electrolytes for suspected hyperkalemia. What is the
nurse’s best immediate action?
A. Proceed to send the specimen to the lab because the room
number is provided.
B. Draw a new, correctly identified specimen from the patient
before sending any blood to the lab.
C. Call the sending unit to confirm the patient identity and
accept the labeled tube as adequate.
,D. Send the tube and document that identification was
incomplete; notify the physician if results are abnormal.
Correct answer: B
Rationale — Correct (B): Patient identification is a preanalytic
safety requirement; unlabeled or inadequately identified
specimens must be recollected to prevent wrong-patient testing
and potential harm. Recollecting with direct two-identifier
verification (name and armband or MRN) ensures result–
patient matching before any decision-making. This aligns with
the clinician’s role in preventing preanalytic errors.
Rationale — Incorrect (A): Sending the unlabeled specimen
risks reporting results for the wrong patient — an unacceptable
safety risk.
Rationale — Incorrect (C): Calling the sending unit does not
meet bedside two-identifier verification; the specimen must be
tied directly to the patient at bedside.
Rationale — Incorrect (D): Documenting and sending an
inadequately identified specimen does not mitigate the safety
hazard; recollection is required before relying on results.
Teaching point: Always verify two patient identifiers at bedside
before collecting or accepting specimens.
Fischbach, F., Fischbach, M., & Stout, K. (2024). A Manual of
Laboratory and Diagnostic Tests (11th ed.). Ch. 1.
,Ch. 1 — Diagnostic Testing
Stem: A nurse inspects a serum tube before sending it to the
lab and notes a pinkish tinge to the serum and many small red
cells in the specimen. The clinician ordered a potassium level.
What is the most likely interpretation and appropriate nursing
action?
A. The sample is hemolyzed; redraw the specimen because
hemolysis can falsely elevate potassium.
B. The sample is icteric; proceed because icterus does not affect
potassium measurement.
C. The sample is lipemic; centrifuge and send—lipemia only
interferes with cholesterol assays.
D. The pink color indicates high bilirubin; notify the physician of
likely hyperbilirubinemia.
Correct answer: A
Rationale — Correct (A): Visible hemolysis (pink/red serum)
indicates red cell rupture; intracellular potassium is released,
producing spuriously high potassium values. The preanalytic
error must be corrected by recollection with proper
phlebotomy technique to avoid false results and inappropriate
treatment.
Rationale — Incorrect (B): Icterus (yellow/brown serum) differs
visually and affects some assays but does not cause the pink-red
hue; hemolysis specifically elevates potassium.
Rationale — Incorrect (C): Lipemia appears milky; while it
interferes with some assays, the described appearance and red
, cells indicate hemolysis, not lipemia.
Rationale — Incorrect (D): Pink serum is not caused by high
bilirubin; bilirubin produces a yellow-brown color.
Teaching point: Recognize hemolyzed specimens—redraw
when hemolysis may alter critical analytes (e.g., potassium).
Fischbach, F., Fischbach, M., & Stout, K. (2024). A Manual of
Laboratory and Diagnostic Tests (11th ed.). Ch. 1.
Ch. 1 — Diagnostic Testing
Stem: A patient scheduled for a 12-hour fasting lipid panel
reports eating a pastry 2 hours before collection. The lab
collection technician asks you whether to proceed. What is the
best nursing response?
A. Proceed with collection; a single snack will not significantly
affect results.
B. Document the snack and proceed—interpretation can
account for the deviation.
C. Cancel and reschedule the test for a fasting specimen
because nonfasting intake alters triglycerides.
D. Proceed but draw a second nonfasting specimen to compare
results.
Correct answer: C
Rationale — Correct (C): Pretest patient preparation is critical;
eating before a fasting lipid panel, especially carbohydrate/fat
containing foods, alters triglyceride and LDL calculations.
LABORATORY AND DIAGNOSTIC TESTS.
11TH EDITION
• AUTHOR(S)FRANCES FISCHBACH;
MARGARET FISCHBACH; KATE STOUT
TESTBANKS
Ch. 1 — Diagnostic Testing
Stem: A nurse in the ED receives a blood specimen from a
different unit labeled with the room number but without the
patient’s name or armband verification. The attending requests
stat electrolytes for suspected hyperkalemia. What is the
nurse’s best immediate action?
A. Proceed to send the specimen to the lab because the room
number is provided.
B. Draw a new, correctly identified specimen from the patient
before sending any blood to the lab.
C. Call the sending unit to confirm the patient identity and
accept the labeled tube as adequate.
,D. Send the tube and document that identification was
incomplete; notify the physician if results are abnormal.
Correct answer: B
Rationale — Correct (B): Patient identification is a preanalytic
safety requirement; unlabeled or inadequately identified
specimens must be recollected to prevent wrong-patient testing
and potential harm. Recollecting with direct two-identifier
verification (name and armband or MRN) ensures result–
patient matching before any decision-making. This aligns with
the clinician’s role in preventing preanalytic errors.
Rationale — Incorrect (A): Sending the unlabeled specimen
risks reporting results for the wrong patient — an unacceptable
safety risk.
Rationale — Incorrect (C): Calling the sending unit does not
meet bedside two-identifier verification; the specimen must be
tied directly to the patient at bedside.
Rationale — Incorrect (D): Documenting and sending an
inadequately identified specimen does not mitigate the safety
hazard; recollection is required before relying on results.
Teaching point: Always verify two patient identifiers at bedside
before collecting or accepting specimens.
Fischbach, F., Fischbach, M., & Stout, K. (2024). A Manual of
Laboratory and Diagnostic Tests (11th ed.). Ch. 1.
,Ch. 1 — Diagnostic Testing
Stem: A nurse inspects a serum tube before sending it to the
lab and notes a pinkish tinge to the serum and many small red
cells in the specimen. The clinician ordered a potassium level.
What is the most likely interpretation and appropriate nursing
action?
A. The sample is hemolyzed; redraw the specimen because
hemolysis can falsely elevate potassium.
B. The sample is icteric; proceed because icterus does not affect
potassium measurement.
C. The sample is lipemic; centrifuge and send—lipemia only
interferes with cholesterol assays.
D. The pink color indicates high bilirubin; notify the physician of
likely hyperbilirubinemia.
Correct answer: A
Rationale — Correct (A): Visible hemolysis (pink/red serum)
indicates red cell rupture; intracellular potassium is released,
producing spuriously high potassium values. The preanalytic
error must be corrected by recollection with proper
phlebotomy technique to avoid false results and inappropriate
treatment.
Rationale — Incorrect (B): Icterus (yellow/brown serum) differs
visually and affects some assays but does not cause the pink-red
hue; hemolysis specifically elevates potassium.
Rationale — Incorrect (C): Lipemia appears milky; while it
interferes with some assays, the described appearance and red
, cells indicate hemolysis, not lipemia.
Rationale — Incorrect (D): Pink serum is not caused by high
bilirubin; bilirubin produces a yellow-brown color.
Teaching point: Recognize hemolyzed specimens—redraw
when hemolysis may alter critical analytes (e.g., potassium).
Fischbach, F., Fischbach, M., & Stout, K. (2024). A Manual of
Laboratory and Diagnostic Tests (11th ed.). Ch. 1.
Ch. 1 — Diagnostic Testing
Stem: A patient scheduled for a 12-hour fasting lipid panel
reports eating a pastry 2 hours before collection. The lab
collection technician asks you whether to proceed. What is the
best nursing response?
A. Proceed with collection; a single snack will not significantly
affect results.
B. Document the snack and proceed—interpretation can
account for the deviation.
C. Cancel and reschedule the test for a fasting specimen
because nonfasting intake alters triglycerides.
D. Proceed but draw a second nonfasting specimen to compare
results.
Correct answer: C
Rationale — Correct (C): Pretest patient preparation is critical;
eating before a fasting lipid panel, especially carbohydrate/fat
containing foods, alters triglyceride and LDL calculations.
