Question 1

The nurse is caring for a patient who has had a craniotomy.The patient appears to need endotracheal suctioning.The nurse is aware that this can be of concern because suctioning can cause which of the following? (Select all that apply. )

Accepted Answer

Sometimes suctioning provokes violent coughing,causes vomiting and aspiration of stomach contents,and induces constriction of pharyngeal,laryngeal,and bronchial muscles.In addition,suctioning may cause hypoxemia or vagal overload,resulting in cardiopulmonary compromise and increased intracranial pressure.

Question 2

A timed urine collection can be used for which of the following? (Select all that apply. )

Accepted Answer

Some tests of renal function and urine composition require urine to be collected over 2 to 72 hours.The 24-hour timed collection is most common.These tests measure for elements such as amino acids,creatinine,hormones,glucose,and adrenocorticosteroids,whose levels fluctuate throughout the day.A timed urine collection also can serve as a means to measure the concentration or dilution of urine.Bacteria count and color can be determined through a routine urinalysis.

Question 3

When obtaining laboratory specimens,the nurse needs to be aware that: (Select all that apply. )

Accepted Answer

The nurse should recognize that specimen collection may cause anxiety,embarrassment,and/or discomfort.Cultural considerations are important when collecting specimens and performing diagnostic procedures.Culture and beliefs may affect a patient's response and willingness to participate in specimen collection.Use of a patient's room number is not an acceptable identifier,and the nurse should follow standard precautions when collecting specimens of blood or other body fluids.

Question 4

When collecting specimens,the nurse should: (Select all that apply. )

Accepted Answer

When collecting specimens,wear gloves,and perform hand hygiene.Also,handle excretions discreetly.Invasive collection procedures and fear of unknown test results often cause patients anxiety.Patients who receive a clear explanation about the purpose of the specimen and how the nurse will obtain it are more cooperative.Give patients proper instruction to collect their own specimens of urine,stool,and sputum,thus avoiding embarrassment.

Question 5

The patient is diagnosed with suspected bacteremia.The physician has ordered blood cultures from two different sites.The patient is complaining of chills and has an elevated temperature.What action should the nurse take in the presence of these symptoms?

Accepted Answer

Because bacteremia may be accompanied by fever and chills,blood cultures should be drawn when the patient is experiencing these clinical signs.It is important that at least two culture specimens be drawn from two different sites.Bacteremia exists when both cultures grow the infectious agent.Because blood culture specimens obtained from an IV catheter are frequently contaminated,tests that use them should not be performed unless catheter sepsis is suspected.

Question 6

What should the nurse do after obtaining a sample for an arterial blood gas (ABG)?

Accepted Answer

Maintain continuous pressure on and proximal to the site for 3 to 5 minutes.Palpate the artery below or distal to the puncture site to determine whether pulse quality has changed,indicating alteration in arterial flow.Place a syringe in a cup of crushed ice.Failure to do this may result in decreased pH,arterial oxygen pressure (PaO?),and oxygen saturation.Apply warm compresses to enhance the absorption of blood.

Question 7

An appropriate technique for the nurse to implement when preparing for a venipuncture is to:

Accepted Answer

Apply the tourniquet by encircling the extremity and pulling one end of the tourniquet tightly over the other,looping one end under the other,so it can be removed by pulling the end with a single motion.Apply the tourniquet 2 to 4 inches above the venipuncture site selected.Palpate the distal pulse below the tourniquet;if the pulse is not palpable,reapply the tourniquet more loosely.

Question 8

A patient is to have a venipuncture to obtain a blood sample to check ammonia levels.What should the nurse do when given this information?

Accepted Answer

Some specimens have special collection requirements before or after specimen collection.For ammonia levels,tubes must be placed on ice for delivery to the laboratory.For cryoglobulin levels,use pre-warmed test tubes.For vitamin levels,avoid exposure of the test tube to light.For lactic acid levels,do not use a tourniquet.

Question 9

When performing a venipuncture,the nurse should:

Accepted Answer

Place the thumb or forefinger of the nondominant hand 1 inch below the site and gently pull the skin taut.Stretch the skin down until the vein is stabilized.Hold a syringe and needle at a 15- to 30-degree angle from the patient's arm with the bevel up.Palpate for a firm vein that rebounds.Do not use veins that feel rigid or cordlike;a thrombosed vein is rigid,rolls easily,and is difficult to puncture.Allowing alcohol to dry completes its antimicrobial task and reduces the "sting" of venipuncture.Alcohol left on the skin can cause hemolysis of the sample.

Question 10

When obtaining a venipuncture sample for a blood culture,the nurse should:

Accepted Answer

Collect 10 to 15 mL of venous blood by venipuncture in a 20-mL syringe from each venipuncture site.Culture specimens must be obtained from two sites.Dispose of needles,syringe,and soiled equipment in the proper container.Do not cap the needles.Mix gently after inoculation.If both aerobic and anaerobic cultures are needed,inoculate the anaerobic culture first.

Question 11

When blood specimens are drawn,which of the following statements is true?

Accepted Answer

Some specimens have special collection requirements before or after specimen collection,for example,for lactic acid levels,do not use a tourniquet.For cryoglobulin levels,use pre-warmed test tubes.For ammonia and ionized calcium levels,place the tube in ice for delivery to the laboratory.For vitamin levels,avoid exposure of the test tube to light.

Question 12

The nurse is preparing to perform a venipuncture on a patient.Which of the following is an appropriate action for the nurse to take?

Accepted Answer

Do not keep a tourniquet on the patient longer than 1 minute.Prolonged tourniquet application causes stasis,localized acidemia,and hemoconcentration.Palpate the distal pulse (e.g. ,brachial)below the tourniquet.If the pulse is not palpable,reapply the tourniquet more loosely.Ask the patient to open and close the fist several times,finally leaving the fist clenched.Instruct the patient to avoid vigorous opening and closing of the fist.Palpate for a firm vein that rebounds;a patent,healthy vein is elastic and rebounds on palpation.

Question 13

An appropriate technique for the nurse to implement when obtaining an arterial blood gas (ABG)specimen is to:

Accepted Answer

Hold the needle bevel up,and insert the needle at a 45-degree angle into the artery.Use a 23- to 25-gauge needle.Aspirate 0.5-mL sodium heparin into a syringe,and then eject all heparin in the barrel out of the syringe.Allow arterial pulsations to pump 2 to 3 mL of blood into the heparinized syringe slowly to reduce the presence of air bubbles.

Question 14

The nurse is drawing blood from a patient to determine the blood alcohol level.Which step is an appropriate action for the nurse to take?

Accepted Answer

If drawing a sample for a blood alcohol level or blood culture,use only an antiseptic swab,not an alcohol swab.Do not keep a tourniquet on the patient longer than 1 minute.

Question 15

In explaining to the patient about obtaining a sputum specimen to diagnose tuberculosis,the nurse explains which of the following? (Select all that apply. )

Accepted Answer

Specimens for acid-fast bacilli (AFB)require three consecutive morning samples,and cultures can take up to 8 weeks.The ideal time to collect sputum is early morning because bronchial secretions tend to accumulate during the night.Bacteria also accumulate as secretions pool.

Question 16

Hemoccult testing helps to reveal blood that is visually undetectable.This test is a useful diagnostic tool for which of the following conditions? (Select all that apply. )

Accepted Answer

This test is a useful diagnostic tool for conditions such as colon cancer,upper gastrointestinal ulcers,and localized gastric parasitic infection or intestinal irritation.The amount of bleeding increases with the size of the polyp and the stage of cancer.People with small polyps (less than 1 cm in diameter)bleed scarcely more than those without polyps.

Question 17

Assessment of the chemical properties of urine is done by immersing a special,chemically prepared strip of paper into a clean urine specimen,or by combining drops of urine with chemically prepared tablets.The _____________ of the strip or tablet indicates the presence of any of unique chemical properties.

Accepted Answer

The answer of Assessment of the chemical properties of urine...

Question 18

Which of the following is the site of choice for obtaining samples for an arterial blood gas (ABG)?

Accepted Answer

The radial artery is the safest,most accessible site for puncture;it is superficial,is not adjacent to large veins,and usually has adequate collateral circulation by the ulnar artery.Its use is relatively painless if the periosteum is avoided,and it is used when Allen's test is positive.The brachial artery has reasonable collateral blood flow but is less superficial,is more difficult to palpate and stabilize,and carries increased risk for venous puncture;its use results in increased discomfort.The femoral artery should not be used by nurses without specialized training.The popliteal artery usually is not used.

Question 19

When teaching about the procedure for capillary puncture,the nurse instructs a patient to:

Accepted Answer

Clean the site with an antiseptic swab,and allow it to dry completely.Alcohol left on the skin can cause hemolysis of the sample.Hold the finger to be punctured in a dependent position while gently massaging the finger toward the puncture site to increase blood flow to the area before puncture.Select the lateral side of the finger;be sure to avoid the central top of the finger,which has a more dense nerve supply.

Question 20

An appropriate technique for the nurse to use when culturing wound drainage that is suspected to contain anaerobic bacteria is to:

Accepted Answer

Take a swab from a special anaerobic culture tube,swab deeply into the draining body cavity,and rotate gently.Remove the swab and return it to the culture tube,or insert the tip of a syringe into the tube,and aspirate 5 to 10 mL of exudate.Cleanse the area around the wound edges with an antiseptic swab.This removes old exudate and skin flora,preventing possible contamination of the specimen.Never collect exudate from the skin unless it is a separate culture and is labeled as such.

Quiz 7: Specimen Collection