FISCHBACH'S A MANUAL OF
LABORATORY AND DIAGNOSTIC TESTS.
11TH EDITION
• AUTHOR(S)FRANCES FISCHBACH;
MARGARET FISCHBACH; KATE STOUT
TESTBANKS
Ch. 1 — Diagnostic Testing
Q1 — Preanalytic error with hemolyzed sample
A 62-year-old male’s BMP report returned with potassium 6.3
mEq/L, but the patient is asymptomatic and prior potassium
values were 4.2–4.6. The laboratory notes “marked hemolysis”
on the specimen. Which action should the nurse take first?
A. Administer IV calcium gluconate immediately because K+ is
critically high.
B. Notify the provider and request the lab repeat the
plasma/serum specimen obtained by venipuncture.
C. Document result in chart and schedule repeat BMP
,tomorrow morning.
D. Give oral potassium binder because the value is clearly
elevated.
Correct: B
Rationale — Correct (B): Hemolysis releases intracellular
potassium from red cells, producing a spurious hyperkalemia.
Chapter 1 emphasizes verifying suspected preanalytic errors
(hemolysis, clotting, contamination) by recollecting a properly
drawn specimen before initiating treatment. Repeating the
specimen rules out false critical values.
Incorrect — A: Immediate treatment is reserved for
symptomatic or confirmed severe hyperkalemia; with evidence
of hemolysis, confirm the value first.
Incorrect — C: Waiting until next day risks missing a true
abnormality if present; the immediate step after suspected
preanalytic error is repeat collection.
Incorrect — D: Giving a binder treats true hyperkalemia;
without confirming the result and given hemolysis, this is
premature.
Teaching point: Suspected hemolysis mandates repeat properly
drawn specimen before treatment.
Citation: Fischbach, F., Fischbach, M., & Stout, K. (2021). A
Manual of Laboratory and Diagnostic Tests (11th ed.). Ch. 1.
Ch. 1 — Diagnostic Testing
,Q2 — Pretest patient preparation and fasting
A nurse prepares a patient for lipid panel testing scheduled this
morning. The patient reports eating a donut two hours prior.
Based on Chapter 1 guidance, the nurse should:
A. Proceed; most lipid tests are unaffected by recent intake.
B. Cancel the test permanently; patient is ineligible for lipid
screening.
C. Reschedule or postpone the lipid draw to ensure a 9–12 hour
fasting period per standard preparation.
D. Draw the specimen now and mark “nonfasting”; no further
action needed.
Correct: C
Rationale — Correct (C): Chapter 1 stresses following
specimen-specific patient preparation instructions; a fasting
lipid panel requires an appropriate fasting interval (generally 9–
12 hours) to avoid postprandial triglyceride elevation and
misinterpretation. Rescheduling or postponing the draw to
meet fasting requirements ensures valid results.
Incorrect — A: Many lipid values, particularly triglycerides, are
affected by recent intake; proceeding risks inaccurate
interpretation.
Incorrect — B: The test need not be canceled permanently; it
should be rescheduled.
Incorrect — D: Nonfasting results can be annotated, but for
baseline lipid screening the nurse should obtain a fasting
sample when requested.
, Teaching point: Follow test-specific fasting instructions to avoid
misinterpretation from postprandial changes.
Citation: Fischbach, F., Fischbach, M., & Stout, K. (2021). A
Manual of Laboratory and Diagnostic Tests (11th ed.). Ch. 1.
Ch. 1 — Diagnostic Testing
Q3 — Identification and labeling to prevent wrong-patient
errors
A phlebotomy student draws blood from a busy med-surg
patient. The nurse notes the tube is unlabeled and the
phlebotomist is preparing to leave with it. Per Chapter 1, the
nurse’s best action is:
A. Let the phlebotomist leave; relabeling later is acceptable in
lab.
B. Insist on immediate bedside labeling with patient identifiers
before the specimen leaves the room.
C. Ask the phlebotomist to write the patient’s room number on
the tube instead of name.
D. Send a duplicate specimen later and let lab reconcile the
unlabeled one.
Correct: B
Rationale — Correct (B): Chapter 1 emphasizes the critical
safety rule: label specimens at the bedside immediately after
collection with at least two identifiers (name and DOB or
medical record number). This prevents wrong-patient errors
LABORATORY AND DIAGNOSTIC TESTS.
11TH EDITION
• AUTHOR(S)FRANCES FISCHBACH;
MARGARET FISCHBACH; KATE STOUT
TESTBANKS
Ch. 1 — Diagnostic Testing
Q1 — Preanalytic error with hemolyzed sample
A 62-year-old male’s BMP report returned with potassium 6.3
mEq/L, but the patient is asymptomatic and prior potassium
values were 4.2–4.6. The laboratory notes “marked hemolysis”
on the specimen. Which action should the nurse take first?
A. Administer IV calcium gluconate immediately because K+ is
critically high.
B. Notify the provider and request the lab repeat the
plasma/serum specimen obtained by venipuncture.
C. Document result in chart and schedule repeat BMP
,tomorrow morning.
D. Give oral potassium binder because the value is clearly
elevated.
Correct: B
Rationale — Correct (B): Hemolysis releases intracellular
potassium from red cells, producing a spurious hyperkalemia.
Chapter 1 emphasizes verifying suspected preanalytic errors
(hemolysis, clotting, contamination) by recollecting a properly
drawn specimen before initiating treatment. Repeating the
specimen rules out false critical values.
Incorrect — A: Immediate treatment is reserved for
symptomatic or confirmed severe hyperkalemia; with evidence
of hemolysis, confirm the value first.
Incorrect — C: Waiting until next day risks missing a true
abnormality if present; the immediate step after suspected
preanalytic error is repeat collection.
Incorrect — D: Giving a binder treats true hyperkalemia;
without confirming the result and given hemolysis, this is
premature.
Teaching point: Suspected hemolysis mandates repeat properly
drawn specimen before treatment.
Citation: Fischbach, F., Fischbach, M., & Stout, K. (2021). A
Manual of Laboratory and Diagnostic Tests (11th ed.). Ch. 1.
Ch. 1 — Diagnostic Testing
,Q2 — Pretest patient preparation and fasting
A nurse prepares a patient for lipid panel testing scheduled this
morning. The patient reports eating a donut two hours prior.
Based on Chapter 1 guidance, the nurse should:
A. Proceed; most lipid tests are unaffected by recent intake.
B. Cancel the test permanently; patient is ineligible for lipid
screening.
C. Reschedule or postpone the lipid draw to ensure a 9–12 hour
fasting period per standard preparation.
D. Draw the specimen now and mark “nonfasting”; no further
action needed.
Correct: C
Rationale — Correct (C): Chapter 1 stresses following
specimen-specific patient preparation instructions; a fasting
lipid panel requires an appropriate fasting interval (generally 9–
12 hours) to avoid postprandial triglyceride elevation and
misinterpretation. Rescheduling or postponing the draw to
meet fasting requirements ensures valid results.
Incorrect — A: Many lipid values, particularly triglycerides, are
affected by recent intake; proceeding risks inaccurate
interpretation.
Incorrect — B: The test need not be canceled permanently; it
should be rescheduled.
Incorrect — D: Nonfasting results can be annotated, but for
baseline lipid screening the nurse should obtain a fasting
sample when requested.
, Teaching point: Follow test-specific fasting instructions to avoid
misinterpretation from postprandial changes.
Citation: Fischbach, F., Fischbach, M., & Stout, K. (2021). A
Manual of Laboratory and Diagnostic Tests (11th ed.). Ch. 1.
Ch. 1 — Diagnostic Testing
Q3 — Identification and labeling to prevent wrong-patient
errors
A phlebotomy student draws blood from a busy med-surg
patient. The nurse notes the tube is unlabeled and the
phlebotomist is preparing to leave with it. Per Chapter 1, the
nurse’s best action is:
A. Let the phlebotomist leave; relabeling later is acceptable in
lab.
B. Insist on immediate bedside labeling with patient identifiers
before the specimen leaves the room.
C. Ask the phlebotomist to write the patient’s room number on
the tube instead of name.
D. Send a duplicate specimen later and let lab reconcile the
unlabeled one.
Correct: B
Rationale — Correct (B): Chapter 1 emphasizes the critical
safety rule: label specimens at the bedside immediately after
collection with at least two identifiers (name and DOB or
medical record number). This prevents wrong-patient errors
