Deck 6: Specimen Collection and Processing

Question 1

If a test is not considered appropriate for the specimen, the following should happen:

A) Discipline the ward clerk for ordering the wrong test.
B) Discipline the nurse for ordering the wrong test.
C) Hold a training session to teach hospital staff about correctly ordering tests.
D) The laboratory needs to communicate with the physician to determine exactly what needs to be done.

Answer 1

D

Question 2

To assist hospital personnel in collecting the highest quality specimen, the laboratory should

A) post the microbiology laboratory's phone numbers in each section so personnel can call with questions and problems.
B) develop a well-written handbook and make it available at every patient care unit.
C) allow personnel to go to the floor and collect all specimens.
D) severely reprimand staff for not collecting specimens properly.

Answer 2

B

Question 3

What is the primary goal in the transportation of specimens to the laboratory?

A) To get the specimen to the laboratory by the end of the day
B) To maintain the specimen as near its original state as possible with minimal deterioration
C) To place the specimen in formalin and then transport it to the laboratory
D) To allow the specimen to sit, as long as it is delivered to the laboratory within 2 to 3 days after collection

Answer 3

B

Question 4

Swabs are appropriate for specimens collected from all the following sites, except

A) upper respiratory tract.
B) external ear.
C) urine.
D) genital tract.

Question 5

To perform a quality laboratory analysis, the laboratory needs specific information regarding the patient and the specimen. What can be a critical weak link in the specimen management process?

A) Poor specimen collection techniques
B) Incomplete information on the requisition
C) Poor-quality hospital information system
D) Poor-quality laboratory information system

Question 6

A night technician is working in microbiology when a cerebrospinal fluid (CSF) specimen comes in. Almost simultaneously, the technician is called to the emergency department to draw blood on seriously injured car crash victims. How would the technician store the CSF until time permits to work on the CSF specimen?

A) Put the specimen in the refrigerator where it is good for 4 hours at 4° C.
B) Leave the specimen on the shelf where it is good for 6 hours at room temperature.
C) Pour the specimen into a tube of broth.
D) Place the specimen in a 35° C incubator where it is good for up to 6 hours.

Question 7

The best way to minimize the amount of upper respiratory flora in a sputum specimen is to follow which of these procedures?

A) Cough up the specimen and when the specimen gets to the laboratory, digest it with enzymes that will kill the normal flora.
B) When plating the specimen, ensure that the swab goes deep into the sample to get only bacteria present in the lower lung.
C) Have the patient rinse the mouth with water and expectorate with the aid of a really deep cough directly into a sterile container.
D) Have a respiratory technician decontaminate a patient's mouth and throat before the specimen is collected.

Question 8

All the following principles of specimen collection are fundamental to ensuring appropriate specimen management, except:

A) Collect the appropriate quantity of specimen.
B) Label the specimen accurately with the specific anatomic site and the patient information.
C) Select the correct anatomic site to collect the specimen.
D) It is acceptable to delay transport of the specimen to the laboratory if it is in transport media.

Question 9

Sputum specimens are often collected for the diagnosis of

A) acute pharyngitis.
B) bacterial pneumonia.
C) meningitis.
D) diverticulitis.

Question 10

The specimen of choice for detecting gastrointestinal pathogens is

A) a urine specimen.
B) vomit.
C) a swab of the anal area with no feces on it.
D) a stool specimen.

Question 11

Data generated by the laboratory is directly influenced by

A) the quality of the specimen and its condition when received.
B) the physician's decision to do the test.
C) quality control performed on a monthly basis.
D) the air quality in the laboratory.

Question 12

The goal of the specimen collector when collecting specimens for culture should be to

A) make sure the specimen gets to the laboratory.
B) avoid hurting the patient when collecting the specimen.
C) maintain the viability of the living organisms at the site with minimal contamination.
D) get the specimen quickly to get the doctor off the collector's back.

Question 13

Why is clean-catch midstream urine used for a urine culture as opposed to a clean-catch urine?

A) The first portion of the urine flow washes contaminants from the urethra and the next portion of urine is more representative of the bladder.
B) The name was changed, but the procedure remains the same and the entire amount of urine from the bladder is cultured.
C) No urine is free from contamination, so just wipe the external genitalia and void into the cup.
D) Catheterized specimens are also called clean-catch midstream urine specimen.

Question 14

Proper identification of each specimen includes a label firmly attached to the container with all the following information, except

A) diagnosis.
B) name.
C) identification number.
D) date.

Question 15

A safe method of transporting aspirated wound material would be in

A) a leakproof bag.
B) a tube of broth.
C) an anaerobic transport system.
D) a plastic container.

Question 16

How should specimen collection instructions be given to the patient to ensure collection of a good specimen for culture?

A) Written only in English
B) Verbally, in many different languages
C) Verbally, only in English
D) Both verbal and written instruction in simple language

Question 17

If transport of the specimen is delayed, the specimen can be maintained by all of the following, except

A) preservatives.
B) transport or holding medium.
C) saltwater.
D) anticoagulants.

Question 18

The requisition form should provide all the following information, except

A) patient name or identification number.
B) patient age and gender.
C) patient home address.
D) specific anatomic site.

Question 19

Why is it acceptable for a fecal sample to be collected in a nonsterile container?

A) Fecal samples can be runny and if the specimen leaks, this can present a biohazard.
B) Many types of bacteria call the intestinal tract home; the specimen cannot become contaminated.
C) Leakproof containers are always sterile, so the container will be leakproof, as well as sterile.
D) Because DNA probes can determine resident flora from pathogenic bacteria.

Question 20

All specimens must be transported

A) in leakproof secondary containers.
B) in syringes with needles attached.
C) in a tube of broth.
D) in a latex glove.

Question 21

The direct microscopic examination is a useful tool for all the following reasons, except

A) it can tell the physician what type of normal flora is present on the smear and if it is anaerobic or aerobic.
B) it can be used to determine the quality of the specimen.
C) it can give the microbiology technologist and the physician an indication of the infectious process involved.
D) it can dictate the need for nonroutine or additional testing.

Question 22

The purpose of transport media is to

A) make sure the microorganisms can multiply and live as though they were still in the host.
B) keep the swab moist so that the microorganisms do not dry out.
C) ensure the preservation of microorganisms in the specimen.
D) take the place of plating a routine culture with the specimen.

Question 23

Selective media

A) allow the growth of fastidious microbes through the addition of certain growth enhancers.
B) support the grouping of microbes based on different characteristics demonstrated in the media.
C) support the growth of most nonfastidious microbes.
D) support the growth of one type or group of microbes, but not another.

Question 24

Direct microscopic examinations are not recommended for all the following specimen sources, except

A) throat specimens.
B) urethral discharge from a male.
C) nasopharyngeal specimens.
D) vagina specimens.

Question 25

In certain instances, it is desirable for specimens to be inoculated directly onto culture media. Specimens for this pathogen can be placed onto a commercial transport system called a James E. Martin Biological Environmental Chamber (JEMBEC) system. What pathogen is this?

A) Bordetella pertussis
B) Clostridium difficile
C) Francisella tularensis
D) Neisseria gonorrhoeae

Question 26

Notations from the macroscopic (gross) examination of a specimen should include all the following, except

A) swab or aspirate.
B) stool consistency.
C) blood or mucus present.
D) what type of container the specimen was collected in.

Question 27

Differential media

A) support the grouping of microbes based on different characteristics demonstrated in the media.
B) allow the growth of fastidious microbes through the addition of certain growth enhancers.
C) support the growth of most nonfastidious microbes.
D) support the growth of one type or group of microbes, but not another.

Question 28

All of the following are examples of suboptimal specimens that must be rejected, except:

A) The information on the requisition does not match the information on the specimen label.
B) The specimen is for a Neisseria gonorrhoeae (GC) culture and submitted in a JEMBEC system.
C) The specimen container is leaking when received in the laboratory.
D) The specimen is received in a fixative solution such as formalin.

Question 29

A technician receives a package from a supplier of quality control microorganisms. The package has a small watertight vial in a larger watertight tube. The larger tube has some bubble wrap around it, but the larger tube is just placed in the fiberboard box. All of the following was right with this packaging, except:

A) The microorganisms are placed in a small watertight vial.
B) The small vial is placed in a larger watertight tube.
C) The primary receptacle was placed into the secondary container with no absorbent material.
D) The outer container is made of fiberboard.

Question 30

Two types of specimens can use preservatives to maintain them until they can be delivered to the laboratory. They are

A) urine, stool.
B) urine, vaginal secretions.
C) stool, throat cultures.
D) pus from a wound, vaginal secretions.

Question 31

All of the four levels represent a possible scheme for prioritizing the handling of specimens, except

A) Level 1: critical.
B) Level 2: unprotected.
C) Level 3: quantitation required.
D) Level 4: anticoagulated.

Question 32

An enrichment broth is

A) a broth that has growth enhancers to allow fastidious organisms to flourish.
B) used as a supplement to agar plates to detect small numbers of most aerobes, anaerobes, and microaerophiles.
C) a liquid medium designed to encourage the growth of small numbers of a particular organism while suppressing other flora.
D) a broth that allows the grouping of microbes based on different characteristics demonstrated in the medium.

Question 33

Types of specimens that can be batch processed, including all the following, except

A) specimens for fastidious organisms.
B) specimens for acid-fast bacillus (AFB) cultures.
C) stool specimens for ova and parasite tests that are collected in preservatives.
D) specimens for viral culture collected in viral transport media.

Question 34

Enriched media

A) support the grouping of microbes based on different characteristics demonstrated in the media.
B) allow the growth of fastidious microbes through the addition of certain growth enhancers.
C) support the growth of most nonfastidious microbes.
D) support the growth of one type or group of microbes, but not another.

Question 35

The shipment of clinical specimens and cultures of microorganisms is governed by a complex set of national and international guidelines issued by

A) The Department of Transportation (DOT) and the U.S. Postal Service.
B) The Department of Agriculture and the United Parcel Service.
C) The Department of Energy and Federal Express.
D) The Department of Defense and Homeland Security.

Question 36

How does the DOT define an infectious substance?

A) Any substance capable of transmitting disease
B) A material known to contain or is suspected of containing a pathogen that causes disease in humans or animals
C) Any substance that can cause disease in animals
D) A bacterium, virus, prion, or virion

Question 37

Specimens such as blood, bone marrow, and synovium are mixed with anticoagulants right after collection. Why should this occur?

A) Anticoagulants often dissolve part of the bacteria's cell wall and congeal many bacteria into groups.
B) Organisms become bound up in the clotted material and are difficult to isolate.
C) It ensures the specimen will work when using an automated spreader device.
D) It kills off the normal flora and only leaves the pathogens in the specimen.

Question 38

Nonselective media supports

A) the grouping of microbes based on different characteristics demonstrated in the media.
B) the growth of one type or group of microbes, but not another.
C) the growth of most nonfastidious microbes.
D) the growth of fastidious microbes through the addition of certain growth enhancers.

Question 39

How is culture media selected for specimen plating?

A) Determine the supplemental agar needed, as well as the broth media.
B) Always include nonselective media and differential media to help save a day of reading the culture on the bench.
C) Use only broth for the initial inoculation and subculture to plates after 24 hours of incubation.
D) The selection of media to inoculate is based on the type of specimen submitted for culture and the organisms likely to be involved in the infectious process.

Question 40

The technician in the laboratory has received a specimen that is rejected. The technician calls the physician and tells the physician the specimen is unacceptable and the reason why. The physician insists that the culture needs to be performed on this unacceptable culture. What should the technician do?

A) Have the laboratory manager call the physician and tell him that a new specimen needs to be resubmitted because the laboratory will not perform a culture on this specimen.
B) Throw the specimen away and request a new one from the physician.
C) Plate the culture, but include a comment explaining the potentially compromised test results.
D) Discard both the specimen and the requisition, and pretend that the specimen was never received in the laboratory.

Question 41

Aerobes are bacteria that grow

A) in low oxygen tension.
B) in high carbon dioxide concentrations.
C) in high nitrogen concentrations.
D) in ambient air.

Question 42

When using the isolation streaking technique, the greatest concentration of organisms (if present) will be in which quadrant?

A) Fourth
B) Third
C) Second
D) First

Question 43

Microaerophiles are bacteria that grow

A) in low oxygen concentrations.
B) in high carbon dioxide concentrations.
C) in reduced oxygen concentrations but increased carbon dioxide concentrations.
D) where little or no oxygen is present.

Question 44

To help the microbiologist report microbiology results to the physician in a timely fashion to ensure the appropriate treatment, the technician may use this report.

A) Antibiogram
B) Infection control summary
C) Preliminary
D) Final

Question 45

All of the following are questions that the microbiology technologist will ask while reading and interpreting the growth of cultures, except: 1. What is the specimen source?
2) Does this source have normal flora, or is it a sterile source?
3) If there is normal flora, what bacteria are found and what do these colonies look like?
4) What are the most likely pathogens in this specimen?
5) What is the colonial morphology of these pathogens?
6) Which media are demonstrating growth and what is the purpose of the media?

A) What is the source of the culture?
B) How long has this culture been incubated?
C) Does this source have normal flora, or is it a sterile source?
D) What are the most likely pathogens in this specimen?

Question 46

Anaerobes are bacteria that grow

A) in increased carbon dioxide concentrations.
B) in low oxygen concentrations.
C) in reduced oxygen concentrations but increased carbon dioxide concentrations.
D) where little or no oxygen is present.

Question 47

Capnophiles are bacteria that grow

A) in increased carbon dioxide concentrations.
B) in low oxygen concentrations.
C) in reduced oxygen concentrations but increased carbon dioxide concentrations.
D) where little or no oxygen is present.

Question 48

If a 0.001 mL quantitative loop is used to inoculate plate media for a urine culture, each colony of growth represents how many organisms per milliliter in the original sample?

A) 1 organism
B) 10 organisms
C) 100 organisms
D) 1000 organisms

Question 49

What technique is used to isolate bacterial colonies when inoculating organisms onto an agar plate?

A) Homogenization
B) Centrifugation
C) Isolation streaking
D) Culture streaking

Question 50

What method is used to concentrate specimens to increase recovery of pathogens in the microbiology laboratory?

A) Homogenization
B) Centrifugation
C) Mixing
D) Anticoagulation

Question 51

Most bacterial cultures are incubated at this temperature range.

A) 25° C to 27° C
B) 30° C to 40° C
C) 35° C to 37° C
D) 40° C to 42° C

Question 52

What work practice have microbiologists incorporated to keep laboratory testing cost-effective while providing optimum patient care?

A) Using definitive identification for the standard of quality patient care
B) Always identifying organisms to the maximum extent
C) Limited identification procedures
D) Limited antimicrobial susceptibility procedures

Question 53

Cultures for anaerobes and broth cultures may be incubated for

A) 5 to 7 days.
B) 48 to 72 hours.
C) 7 to 9 days.
D) 12 to 24 hours.

Question 54

Nonroutine specimens can include all the following specimen types, except

A) vein grafts.
B) syringe needles.
C) water samples.
D) multiple-lumen catheters.

Question 55

When plating a nonroutine culture on primary culture media, the technician should ask all the following questions, except: 1. If the number of organisms is extremely low, is it important to enhance them?
2) Does the specimen contain any preservative or growth inhibitors that must be counteracted?
3) What is a reasonable amount to culture?

A) What anaerobic bacteria will be present in this specimen?
B) Is the specimen likely to contain low numbers or high numbers of organisms?
C) Are the organisms to be found in this specimen likely to be fastidious or nonfastidious?
D) Are any normal flora presently associated with the specimen?

Question 56

Routine primary plating media include all the following items, except

A) special biochemical media.
B) nonselective agar plate.
C) selective and differential medium for enteric gram-negative bacilli for most routine bacterial cultures.
D) broth medium used as a supplement.

Question 57

When using the isolation streaking technique, the most isolated forms of the organism should be in which quadrant?

A) Fourth
B) Third
C) Second
D) First