Review Practice Exercise 2

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Practice Exercise 2

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Total Questions : 4

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Question 1:

A 78-year-old male client needs to complete a 24-hour urine specimen. In planning his care, the nurse realizes that which measure is most important?

A. Instruct the client to empty his bladder and save this voiding to start the collection. B. Instruct the client to use sterile individual containers to collect the urine. C. Post a sign stating “Save All Urine” in the bathroom. D. Keep the urine specimen in the refrigerator.

Answer and Explanation

Choice A:

The first voiding at the start of the 24-hour collection period must be completely discarded rather than saved. Discarding the initial specimen empties the bladder of residual urine accumulated before the exact start time, ensuring the collection captures only metabolic components produced within the true duration of the scheduled test.

Choice B:

A 24-hour urine collection does not require sterile individual collection containers for each subsequent voiding. The specimen is typically collected into a large, clean, non-sterile container provided by the laboratory, as the test measures chemical analytes and total volume rather than identifying active bacterial growth or microorganisms.

Choice C:

Posting a sign in the client's restroom is the most critical action to prevent inadvertent specimen disposal. If any urine is accidentally discarded during the 24-hour timeframe, the entire collection is invalidated and must be completely restarted. Clear communication via visual alerts ensures that all healthcare providers and the client maintain compliance with the strict protocol.

Choice D:

While keeping the urine cold is standard to prevent bacterial proliferation and decomposition, it is secondary to ensuring no urine is lost. Refrigeration or keeping the container on ice preserves chemical stability of the components, but it is useless if the collection is ruined by someone discarding an unrecorded void.

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Question 2:

The client is supposed to have a fecal occult blood test done on a stool sample. The nurse is going to use the Hemoccult test. Which of the following indicates that the nurse is using the correct procedure? Select all that apply

A. Mixes the reagent with the stool sample before applying to the card. B. Collects a sample from two different areas of the stool specimen. C. Assesses for a blue color change. D. Asks a colleague to verify the pink color results. E. Asks the client if he has taken vitamin C in the past few days.

Answer and Explanation

Choice A:

Mixing the developer reagent directly with the stool sample before card application violates the standard manufacturing protocol. The raw stool specimen must be smeared as a thin film directly onto the designated paper windows first, allowing it to dry slightly before the stabilizing reagent drops are applied to the reverse side.

Choice B:

Collecting specimens from two distinct areas of the fecal matter increases diagnostic sensitivity for localized gastrointestinal pathology. Bleeding from colorectal polyps or malignant lesions is often irregular and not uniformly distributed throughout the stool. Sampling separate locations ensures favorable detection of localized occult blood drops.

Choice C:

Assessing for a blue color change on the guaiac paper confirms a positive reaction for occult blood. The structural iron in hemoglobin acts as a catalyst when developer solution is added, oxidizing the alpha-guaiaconic acid reagent into a quinone structure. This chemical transition turns the testing window blue, signaling gastrointestinal hemorrhage.

Choice D:

Requesting a colleague to verify a pink color reaction reflects a misunderstanding of guaiac-based colorimetric results. A positive reaction specifically produces a distinct blue or cyan hue rather than a pink pigmentation. Chasing a pink indicator would cause an incorrect interpretation of a completely negative test window.

Choice E:

Screening the client for recent high-dose ascorbic acid ingestion prevents false-negative diagnostic outcomes. Vitamin C is a potent antioxidant that directly interferes with the chromogenic oxidation reaction on the guaiac paper, inhibiting the color change despite the presence of blood. Validating ascorbic intake preserves test accuracy.

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Question 3:

A nurse is teaching a male client how to obtain a clean-catch midstream urine specimen for culture and sensitivity testing. Which of the following actions should the nurse instruct the client to perform? Place the steps in the correct order.

A. Wash hands. B. Pull back the foreskin (uncircumcised) and clean with a single stroke around the meatus and glans with a towelette using a circular motion starting with the head of the penis at the urethral opening, moving downs the glans shaft. Discard the towelette and cleanse the head of the penis three times using a circular motion and new towelette each time. C. Open the sterile procedure kit and place the lid face down on a firm surface. D. Begin to urinate into the toilet; after the stream starts to flow, place the collection cup under the stream of urine, and collect 30 to 60 cc of urine without touching the skin with the container. E. Tightly place the lid on the container. F. Label the container and place in a plastic biohazard bag.

Answer and Explanation

Choice A:

Choice B:

Choice C:

Choice D:

Choice E:

Choice F:

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Question 4:

The nurse needs to collect a sputum specimen to identify the presence of tuberculosis (TB). Which nursing action(s) is/are indicated for this type of specimen? Select all that apply

A. Collect the specimen in the evening. B. Send the specimen immediately to the laboratory. C. Ask the client to spit into the sputum container. D. Offer mouth care before and after collection of the sputum specimen. E. Collect a specimen for 3 consecutive days.

Answer and Explanation

Choice A:

Collecting the specimen in the evening yields a lower diagnostic yield compared to early morning collections. Sputum secretions pool deeply in the bronchi and alveoli overnight during sleep, making a morning sample the most concentrated and rich in bacillary volume. An evening collection consists mostly of dilute saliva.

Choice B:

Sending the specimen immediately to the laboratory prevents the overgrowth of contaminating oral flora that can compromise test results. Rapid processing ensures the viability of the sample for acid-fast bacilli smear and culture analysis. Delaying delivery can lead to specimen degradation, rendering the diagnostic laboratory sample unusable.

Choice C:

Asking the client to spit into the container results in a contaminated saliva sample rather than deep pulmonary secretions. The client must perform a deep, diaphragmatic cough to clear material directly from the lower bronchioles into the sterile cup. Mere spitting will fail to harvest the necessary endobronchial specimen.

Choice D:

Offering mouth care before collection minimizes oral contamination by removing food particles, saliva, and superficial oral bacteria without introducing antiseptics. Providing mouth care after the procedure cleanses the oral cavity of lingering, foul-tasting sputum secretions. This intervention maintains mucosal hygiene and enhances client comfort.

Choice E:

Collecting sputum specimens for 3 consecutive days maximizes the diagnostic sensitivity needed to isolate the pathogen. Mycobacterium tuberculosis is shed intermittently into the respiratory tract, meaning a single sample might miss the active bacteria. Securing serial morning specimens drastically improves bacterial recovery and diagnostic accuracy.

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Total Questions : 4

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Practice Exercise 2

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