- While collecting a routine urine specimen, the PN observes that the urine is dark, cloudy, and has a strong, foul odor. What is the most appropriate action for the PN to take?
Answer: Report the characteristics of the urine to the registered nurse (RN).
The PN's role is to collect data and report abnormal findings. Dark, cloudy, foul-smelling urine is an abnormal finding that suggests dehydration and/or a urinary tract infection. The PN should report this data to the RN, who can then perform a full assessment and collaborate with the health care provider. While the PN will send the specimen and document, the priority is to communicate the abnormal finding.
- To ensure client safety and accuracy of results, when is the correct time for the PN to label a specimen container?
Answer: At the client's bedside immediately after collecting the specimen.
Labeling the specimen at the client's bedside immediately after collection is a critical safety step. It confirms the specimen belongs to the correct client (using two identifiers) and minimizes the risk of mislabeling or mix-ups. Labeling before collection is risky because the plan might change or the wrong label could be used. Labeling at the nurses' station increases the risk of error.
- The PN is reinforcing dietary instructions for a client scheduled to collect three stool specimens at home for guaiac (occult blood) testing. Which statement by the client indicates a need for further teaching?
Answer: I will make sure to eat plenty of broccoli and turnips.
Certain foods can interfere with guaiac test results. While red meat can cause a false positive, certain raw vegetables high in peroxidase, such as turnips, broccoli, and radishes, can also cause a false-positive result and should be avoided. Avoiding red meat and vitamin C (which can cause a false negative) are correct instructions.
- The PN is collecting a stool specimen from a client who is on contact precautions for Clostridioides difficile. Which infection control measure is a priority?
Answer: Wear a gown and gloves while handling the client's bedpan and the specimen.
C. difficile is transmitted via contact with spores, requiring contact precautions. The priority is wearing appropriate personal protective equipment (gown and gloves) before any contact with the client or contaminated items. Note that C. difficile spores are resistant to alcohol, so soap and water hand hygiene is required after patient care, making option B incorrect. An N95 is for airborne precautions, and standard single bagging is sufficient for specimen transport.
- The practical nurse (PN) is reinforcing instructions for a female client on how to collect a clean-catch midstream urine specimen. Which statement by the client indicates that the teaching has been effective?
Answer: I need to hold my labia apart while I urinate into the cup.
The correct procedure for a female client collecting a clean-catch midstream urine specimen is to separate the labia to prevent contamination from the surrounding skin and then urinating. Wiping from back to front can introduce bacteria into the meatus. The client should urinate a small amount into the toilet first (midstream) to clear the urethra. The container only needs to be filled to the level indicated, not to the top.
- A sputum specimen for culture and sensitivity is ordered for a client with pneumonia. To ensure a high-quality specimen, the PN should plan to collect it at what time?
Answer: In the early morning, shortly after the client awakens.
Sputum specimens are best collected in the early morning because secretions pool in the airways overnight, making it easier to obtain a sample rich in microorganisms. The client should rinse their mouth with water, not antiseptic mouthwash, to reduce contamination from mouth flora. Collecting after a meal can increase the risk of emesis and contamination with food particles.
- The PN needs to obtain a specimen for a rapid strep test. Which area of the mouth should be swabbed?
Answer: The posterior pharynx and the tonsillar pillars.
To obtain an accurate sample for a rapid strep test or throat culture, the swab must touch the areas where the Streptococcus bacteria are most likely to be present. This includes the posterior pharynx and the tonsillar area on both sides. Care should be taken to avoid touching the tongue, cheeks, or uvula, as this can contaminate the specimen with oral flora.
- A client is instructed to provide a stool specimen for ova and parasites (O&P). The PN should reinforce which essential instruction about handling the specimen?
Answer: The specimen must be delivered to the laboratory while it is still warm.
Stool specimens for O&P must be examined while fresh and warm to detect motile trophozoites. Delay in transport or refrigeration can cause the organisms to die, leading to a false-negative result. The specimen must not be contaminated with urine or water. Multiple specimens are often required, but they are collected in separate containers, not mixed.
- A 24-hour urine collection is ordered for a client. The PN begins the collection at 8:00 AM. Which action should the PN take first?
Answer: Instruct the client to void at 8:00 AM, discard the specimen, and then begin the collection.
To start a 24-hour urine collection, the client should empty their bladder, and that first specimen is discarded. This ensures the collection begins with an empty bladder. The time is noted, and all subsequent urine for the next 24 hours is collected. The container must be kept on ice or refrigerated, and the client should be encouraged to maintain normal fluid intake unless otherwise specified.
- The PN is assisting an RN who is collecting blood cultures from a client. The PN recognizes that strict aseptic technique is being followed when which action is observed?
Answer: The RN cleans the tops of the culture bottles with an alcohol wipe before inoculation.
Blood cultures require strict aseptic technique to prevent contamination. This includes cleansing the venipuncture site thoroughly (usually with chlorhexidine) and also cleansing the rubber stopper on the top of each culture bottle with an antiseptic like alcohol before injecting the blood. Palpating the vein after cleansing contaminates the site. Blowing on the site introduces oral flora. A single alcohol pad is insufficient for the required level of skin preparation for a blood culture.
- Before collecting a blood specimen for a type and crossmatch, what is the PN's priority action to ensure client safety?
Answer: Ask the client to state their full name and date of birth.
The absolute priority before any procedure, especially one like a type and crossmatch where an error can be fatal, is positive client identification using at least two identifiers (e.g., name and date of birth). The nurse must compare this information with the client's wristband and the lab requisition. While confirming the order is important, it is not the priority action immediately before collection at the bedside. Room numbers are not reliable identifiers. NPO status is not required for a type and crossmatch.
- The PN receives a container from a client for a sputum culture. The specimen is watery, thin, and clear. What is the PN's most appropriate action?
Answer: Ask the client to try again, reinforcing the need to cough deeply from the lungs.
A thin, watery, and clear specimen is most likely saliva, not sputum from the lower respiratory tract. Sending saliva to the lab for a sputum culture will yield inaccurate results. The PN should recognize the inadequate specimen, provide further instruction to the client on how to produce a deep cough to bring up sputum, and request a new sample. Documenting it as sputum or altering the specimen is incorrect.
- The PN is performing point-of-care urine testing using a reagent strip (dipstick). Which action indicates correct procedure?
Answer: Comparing the strip to the color chart on the bottle at the specified times.
Each test pad on a reagent strip is designed to be read at a specific time (e.g., 30 seconds, 60 seconds, 120 seconds). The color change must be compared to the reference chart on the container at the correct time for an accurate result. The strip should be held horizontally after dipping to prevent reagent from running between pads. The dip should be brief, just enough to saturate the pads.
- The PN needs to collect a sterile urine specimen from a client with an indwelling urinary catheter system. What is the correct action?
Answer: Cleanse the specimen port on the tubing and aspirate urine with a sterile syringe.
To obtain a sterile specimen from an indwelling catheter, the PN must use aseptic technique. This involves cleansing the designated specimen port with an antiseptic wipe and using a sterile syringe to aspirate urine. Disconnecting the system or collecting from the bag introduces a high risk of contamination. The client cannot void normally while the catheter is in place.
- When performing a capillary blood glucose test, which action by the PN demonstrates correct technique?
Answer: Wiping away the first drop of blood with sterile gauze.
The first drop of blood from a capillary puncture contains interstitial fluid and tissue debris, which can alter the blood glucose reading. Therefore, it should be wiped away. The puncture should be on the side of the fingertip, not the center, as it is less painful and has better blood flow. The finger should be gently squeezed, not milked, as milking can also introduce interstitial fluid. The middle or ring finger is preferred over the index finger, which tends to have thicker calluses.
- A client with decision-making capacity politely refuses to provide a stool specimen that was ordered by the primary health care provider. What is the PN's most appropriate initial action?
Answer: Document the client's refusal in the medical record and notify the RN.
Competent clients have the right to refuse treatment and procedures, including specimen collection. The PN's role is to respect the client's autonomy, document the refusal accurately, and report the information to the RN. The RN can then assess the situation further and communicate with the primary health care provider. Trying to coerce the client or involving family against the client's wishes is inappropriate.
- The PN is preparing to obtain a culture from a client's wound that has purulent drainage. Which is the first step in the collection process?
Answer: Cleanse the wound with sterile normal saline.
Before collecting a wound culture, the wound should be cleansed or irrigated with a non-antiseptic solution like sterile normal saline. This removes surface contaminants and old drainage, ensuring the specimen collected reflects the microorganisms actually causing infection within the wound tissue. Swabbing pus, old drainage, or periwound skin can result in an inaccurate culture.
- The PN is collecting a stool specimen for a guaiac test (fecal occult blood test). Which action is a necessary part of the procedure?
Answer: Obtain a sample from two different areas of the stool specimen.
When collecting a stool specimen for a guaiac test, a small sample should be taken from two different parts of the stool because occult blood may not be distributed evenly throughout the specimen. The specimen should be free of urine. Only a thin smear of stool is needed on the test card. Refrigeration is not required for this specific test card method.
- The PN is preparing to perform a capillary blood glucose test on an adult client who is right-handed and works as a musician. Which site is the best choice?
Answer: The side of the left middle finger.
The preferred site for a capillary puncture in an adult is the side of a non-dominant finger, such as the middle or ring finger. Using the non-dominant hand (left, in this case) causes less inconvenience for the client. The sides of the finger are less calloused and have fewer nerve endings than the tip. The heel is used for infants, and the earlobe is a less common alternative site.
- The PN is attempting to collect a sputum specimen from an older adult client who is weak and unable to produce a strong cough. Which action should the PN take first?
Answer: Encourage the client to take several deep breaths and then try to cough again.
The least invasive action should be attempted first. Encouraging the client to take deep breaths can help mobilize secretions and facilitate a more effective cough. Offering a warm beverage may also help, but deep breathing is a more direct first intervention. Notifying the RN for suctioning is appropriate if simpler measures fail. Documentation occurs after all attempts are made.
