A nurse is reinforcing teaching with a client about how to collect a stool specimen. Which of the following instructions should the nurse include?
Urinate after the specimen collection.
Keep the specimen in a warm area.
Place 1.3 cm (0.5 in) of formed stool into a culture tube.
Avoid placing toilet tissue in the bedpan after defecation.
The Correct Answer is D
Choice A reason: This is incorrect because the client should urinate before the specimen collection to avoid contaminating the stool with urine.
Choice B reason: This is incorrect because the specimen should be kept in a cool area to prevent bacterial growth and decomposition.
Choice C reason: This is incorrect because the client should place at least 2.5 cm (1 in) of formed stool or 15 to 30 mL of liquid stool into a culture tube.
Choice D reason: This is correct because the client should avoid placing toilet tissue in the bedpan after defecation to prevent interfering with the laboratory analysis of the stool.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Fidelity is not the ethical principle that the nurse is implementing. Fidelity is the duty to keep one's promises and commitments to the client. The nurse is not demonstrating fidelity by giving pain medication, unless the nurse has promised to do so.
Choice B reason: Beneficence is the ethical principle that the nurse is implementing. Beneficence is the duty to do good and prevent harm to the client. The nurse is demonstrating beneficence by giving pain medication to relieve the client's suffering and promote comfort.
Choice C reason: Autonomy is not the ethical principle that the nurse is implementing. Autonomy is the right of the client to make their own decisions and choices about their health care. The nurse is not demonstrating autonomy by giving pain medication, unless the client has consented to it.
Choice D reason: Veracity is not the ethical principle that the nurse is implementing. Veracity is the duty to tell the truth and be honest with the client. The nurse is not demonstrating veracity by giving pain medication, unless the nurse has explained the purpose, benefits, and risks of the medication.
Correct Answer is B
Explanation
Choice A reason: Client instructed on self-care needs is not a specific or accurate documentation. The nurse should include the details of the instruction, such as the topics covered, the teaching methods used, the client's response, and the evaluation of learning.
Choice B reason: Oral temperature elevated at 0800 is a specific and accurate documentation. The nurse should include the vital signs and any abnormal findings, such as fever, in the client's health record. The nurse should also report the elevation to the provider and monitor the client for signs of infection.
Choice C reason: Episiotomy approximated, 3 cm (1.18 in) in length is not a specific or accurate documentation. The nurse should include the type, location, and degree of the episiotomy, as well as the condition of the wound, the presence of edema, erythema, or drainage, and the interventions performed.
Choice D reason: Client drank adequate amounts of fluid with meals is not a specific or accurate documentation. The nurse should include the exact amount and type of fluid intake, as well as the output, in the client's health record. The nurse should also assess the client for signs of dehydration or fluid overload.
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