A client is to have a Schilling's test. The nurse should:

Appeared in: NHM MP Staff Nurse-2022

Explanation

The Schilling's test is a diagnostic procedure to evaluate the absorption of Vitamin B12 (cobalamin).
The test measures the amount of orally ingested radioactive Vitamin B12 that is absorbed by the gut and subsequently excreted in the urine.
A key nursing responsibility is the accurate and complete collection of all urine produced by the client over a 24 to 48-hour period.
An intramuscular injection of non-radioactive B12 is given to saturate tissue binding sites, ensuring that any absorbed radioactive B12 is passed into the urine for measurement.

Option A: Methylcellulose is a bulk-forming laxative used to treat constipation. It has no diagnostic or therapeutic role in the evaluation of Vitamin B12 absorption.
Option C: While the client is typically NPO (nothing by mouth) for 8-12 hours before the test begins, they do not need to maintain this status for the entire 24-48 hour urine collection period.
Option D: The Schilling test relies on measuring urinary excretion of radioactive B12. Stool collection is not part of this specific test protocol.

Clinical Relevance

Nursing practice connection: Use the key finding related to Nursing management and procedure for the Schilling's test to guide bedside assessment, documentation, and the next nursing action.
Accurate specimen collection is critical for diagnostic integrity. The nurse must ensure that no urine is discarded during the 24-48 hour period, as this would invalidate the test results and lead to an incorrect diagnosis.
Patient education is a key nursing role. The nurse must clearly explain the procedure, the importance of collecting all urine, and how to do so correctly using the provided container.
The Schilling test helps differentiate between pernicious anemia (lack of intrinsic factor) and other causes of B12 malabsorption, guiding appropriate long-term treatment (e.g., B12 injections vs. oral supplements).

How to Approach the Question

First, identify the core subject of the question: the 'Schilling's test'.
Recall the purpose of this test, which is to measure Vitamin B12 absorption.
Think through the mechanism of the test: how is absorption measured? This involves tracking an oral radioactive dose.
Remember that the test measures what is absorbed and then excreted. The key is knowing the route of excretion measured, which is urinary.
This leads directly to the need for a timed urine collection (24-48 hours).
Evaluate the other options to confirm they are incorrect: a laxative (irrelevant), prolonged NPO status (incorrect timing), and stool collection (wrong specimen type).

Concept Tested & Keywords

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E6 PATHOLOGY QUICK REVIEWBased on Harsh Mohan Textbook of PATHOLOGY p. 106-108

E6 Nursing Fundamentals Taylor p. 690-692

Practise the full NHM MP Staff Nurse-2022

Attempt every question from this paper in a timed mock, then review the full solution for each one.