Deck 6: Specimen Collection and Processing

Question 1

Why is a 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.

Answer 1

A
Instructions for urine collection must include an explanation of the clean-catch midstream urine specimen.A first morning specimen is preferred because it provides a more concentrated sample.The patient collects this specimen following cleansing of external genitalia to reduce the presence of indigenous florae.Patients are asked to void without collecting the first portion of the urine and instead to collect the middle portion.The first portion of the urine flow washes contaminants from the urethra and the midstream portion is more representative of the bladder.Personnel collecting catheterized specimens should also use this technique to eliminate organisms carried up the urethra during catheterization.

Question 2

The best way to minimize the amount of upper respiratory florae in a sputum specimen is to follow these procedures:

A) Cough up the specimen, then when the specimen gets to the lab, digest it with enzymes that will kill the normal florae.
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 their mouth with water and expectorate with the aid of a really deep cough directly into a sterile container.
D) Have a respiratory tech decontaminate a patient's mouth and throat before the specimen is collected.

Answer 2

C
Rinsing the mouth will clean out most of the normal florae.A deep cough should gather as much purulent material as possible from the lower lung area.Using enzymes to digest the specimen will kill all bacteria in it,not just the normal florae.Sometimes the sputum is so thick that it is not possible to probe into the middle of the specimen to avoid any outer contaminating florae.It is not practical to have a respiratory tech disinfect a patient's mouth and throat before collecting a sputum specimen.

Question 3

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

A) To get the specimen to the lab 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
The primary goal in the transportation of specimens to the laboratory is to maintain the specimen as near its original state as possible with minimal deterioration and to prevent risk to the specimen handler.Pathogens deteriorate rapidly if there is no food or the right environmental conditions.Formalin will kill most pathogens,so you do not want to place the specimen in formalin.Specimens should be transported to the laboratory ideally within 30 minutes of collection and preferably within 2 hours.

Question 4

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

A) Verbally
B) Verbally, in many different languages
C) Verbally and written in English
D) Written, using simple language (in several languages) and pictures to help the patient understand the procedure as it is verbally explained

Question 5

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 6

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 7

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 8

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

A) Make sure the specimen gets to the lab.
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 9

A night tech is working in microbiology when a cerebrospinal fluid (CSF)specimen comes in.Almost simultaneously,the tech is called to the emergency department to draw blood on seriously injured car accident victims.How would the tech 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 for 6 hours.

Question 10

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

Question 11

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.

Question 12

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 13

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 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 material would be in:

A) A leak-proof bag
B) A tube of broth
C) An anaerobic transport system
D) A plastic container

Question 16

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 in transport media.

Question 17

Sputum specimens are often collected for the diagnosis of:

A) Acute pharyngitis
B) Bacterial pneumonia
C) Meningitis
D) Diverticulitis

Question 18

All specimens must be transported:

A) In leak-proof secondary containers
B) In syringes with needles attached
C) In a tube of broth
D) In a latex glove

Question 19

Why does a fecal sample for culture need to be collected in a leak-proof,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) Leak-proof containers are always sterile, so the container will be leak-proof as well as sterile.
D) Because DNA probes can determine resident florae from pathogenic bacteria.

Question 20

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 21

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 florae and only leaves the pathogens in the specimen.

Question 22

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 florae
D) A broth that allows the grouping of microbes based on different characteristics demonstrated in the medium

Question 23

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 24

How does the Department of Transportation (DOT)define an infectious substance?

A) Any substance capable of transmitting disease
B) A material known to contain or 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 25

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 26

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 27

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 JEMBEC system.What pathogen is this?

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

Question 28

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 29

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 30

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 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

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) Not promote the multiplication of microorganisms but ensure their preservation
D) Take the place of plating a routine culture with the specimen

Question 33

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 34

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 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 35

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 gonorrhea (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 36

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 37

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 38

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 39

Three types of specimens can be batch processed,including all the following EXCEPT:

A) Specimens for Neisseria gonorrhea (GC) cultures
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 40

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 41

Most bacterial cultures are incubated at this temperature range.

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

Question 42

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 43

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 44

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 45

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 46

To quantitate the number of bacteria for a routine urine culture,what size is the calibrated loop that is used?

A) 0.1 mL
B) 0.001 mL
C) 1 mL
D) 0.01 mL

Question 47

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 48

Nonroutine specimens can include all the following specimen types EXCEPT:

A) Vein grafts
B) Syringe needles
C) Water samples
D) Multiple-lumen catheters

Question 49

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

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

Question 50

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

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

Question 51

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

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

Question 52

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 53

When plating a nonroutine culture on primary culture media,the tech should ask all the following questions EXCEPT:

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 florae presently associated with the specimen?

Question 54

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 55

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 56

All of the following are questions that the microbiology technologist will ask while reading and interpreting the growth of cultures EXCEPT:

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

Question 57

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