PN 146 01 CONCEPTS OF PRACTICAL Nursing Nightingale
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Free PN 146 01 CONCEPTS OF PRACTICAL Nursing Nightingale Questions
Which of the following tests requires sterile gloves?
- Performing a Hemoccult test on stool
- Obtaining a wound culture
- Obtaining a midstream urine specimen
- Performing a Gastroccult test
Explanation
Correct Answer: B) Obtaining a wound culture
Obtaining a wound culture requires sterile gloves because it involves direct contact with an open wound — a sterile body site where introduction of microorganisms could cause infection or contaminate the specimen. Hemoccult and Gastroccult tests involve handling stool and gastric contents respectively and require only clean gloves. Assisting a patient with midstream urine collection also requires only clean gloves as the nurse is not directly accessing a sterile body cavity.
The nurse informs the client that the client's fasting blood glucose reading was 86. The client asks the nurse what this means. Which of the following is an accurate response by the nurse?
- "Your blood sugar is within normal range; I will document the finding."
- "I will have to contact your health care provider for further orders."
- "Your blood sugar is too low. I will see if there is an order for insulin."
- "Your blood sugar is too low. I will bring you a snack of orange juice."
- "Your blood sugar is too high. I will see if there is an order for insulin."
Explanation
Correct Answer: A) "Your blood sugar is within normal range; I will document the finding."
A fasting blood glucose of 86 mg/dL falls within the normal fasting range of 70–99 mg/dL. The nurse should accurately inform the client, document the finding, and take no further action as no intervention is required. It is not too low (hypoglycemia is below 70 mg/dL) and not too high, so offering orange juice or checking for insulin orders would be inappropriate and potentially harmful responses.
The nurse has informed the patient a wound culture is going to be obtained. The patient asks why the nurse cleans the wound before swabbing it, stating "Won't that keep any infection from showing up on the test?" Which response by the nurse indicates the correct rationale for cleaning the wound prior to obtaining the culture?
- "Cleaning the wound keeps the wound free of pathogenic microorganisms."
- "Removing skin flora prevents possible contamination of the specimen."
- "Removing drainage minimizes discomfort during the procedure."
- "Cleaning the wound reduces the spread of infection."
Explanation
Correct Answer: B) "Removing skin flora prevents possible contamination of the specimen."
The wound is cleaned before obtaining a culture to remove surface debris, drainage, and normal skin flora (resident microorganisms) that could contaminate the specimen and produce a false or misleading culture result. The goal is to culture the actual organisms causing the wound infection, not surface contaminants. Cleaning does not eliminate pathogenic organisms from within the wound, nor is its primary purpose to reduce discomfort or prevent spread of infection.
Which of the following are reasons for performing lab tests? (Select all that apply.)
- Meets requirements of third party payers (i.e., insurance companies)
- Reduces the need for medication therapy
- Provides information about the stage of a disease process
- Aids in diagnosis of health care problems
- Measures a patient's response to therapy
Explanation
Correct Answers: A) Meets requirements of third party payers, C) Provides information about the stage of a disease process, D) Aids in diagnosis of health care problems, and E) Measures a patient's response to therapy
Laboratory tests serve multiple clinical and administrative purposes: they assist in diagnosing conditions, monitoring disease progression and staging, evaluating a patient's response to treatment, and meeting insurance or third-party documentation requirements. Lab tests do not reduce the need for medication therapy — in fact, they often guide and determine what medications are needed, making option B incorrect.
Which of the following can be determined from Gastroccult testing? (Select all that apply.)
- The amount of bleeding in the stool
- The presence of blood in gastric contents
- Cancerous cells in the stool
- The pH of the gastric contents
Explanation
Correct Answers: B) The presence of blood in gastric contents, and D) The pH of the gastric contents.
Gastroccult testing is specifically designed to detect occult (hidden) blood in gastric contents such as vomitus or nasogastric drainage, and to measure the pH of gastric contents to confirm proper tube placement or assess gastric acidity. It does not quantify the amount of bleeding, nor does it detect cancerous cells. Cancerous cell detection requires cytology or biopsy. The amount of bleeding cannot be determined by a qualitative chemical test like Gastroccult.
The nurse has instructed a patient on the procedure for obtaining a midstream urine specimen. The patient asks, "Why does the urine sample need to be collected in this manner?" The nurse's best response is:
-
"This method will prevent you from developing urinary incontinence by strengthening perineal muscles."
-
"By catching the middle of the urine stream, it provides time to ensure the bladder is completely empty."
-
"It is performed this way in order to verify fresh urine is obtained for testing, increasing accuracy."
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"The initial stream flushes out microorganisms that accumulate at the opening of the urinary tract."
Explanation
Correct Answer: D) "The initial stream flushes out microorganisms that accumulate at the opening of the urinary tract."
The midstream clean-catch technique is used to reduce contamination of the urine specimen. The first portion of urine flushes out microorganisms, skin cells, and debris that colonize the urethral meatus and surrounding area. Collecting the midstream portion therefore provides a more accurate representation of what is actually present in the bladder. The method has no relationship to perineal muscle strengthening, bladder emptiness, or urine freshness specifically.
The nurse informs the patient that their fasting blood glucose reading was 151 mg/dL. The patient asks what this means. Which of the following is the best response by the nurse?
- "Your blood sugar is within normal range. I will document the finding."
- "You don't need to worry; I will contact your health care provider if necessary."
- "Your blood sugar is too low. I will bring you a snack containing carbohydrates."
- "Your blood sugar is too high. I will see if there is an order for insulin."
Explanation
Correct Answer: D) "Your blood sugar is too high. I will see if there is an order for insulin."
A fasting blood glucose of 151 mg/dL is above the normal fasting range of 70–99 mg/dL, indicating hyperglycemia. The nurse's most appropriate response is to inform the patient honestly, then follow up by checking for a sliding scale or insulin order and notifying the provider. It is not within normal range, it is not low, and dismissing the finding without action is unsafe nursing practice.
The health care provider has written the following orders: 0.45% NaCl at 50 mL/hr, C & S (culture & sensitivity) of wound, Levofloxacin 500 mg IV q 24h, Diet as tolerated. Which health care provider's order should receive highest priority?
- Diet as tolerated
- It doesn't matter; just so that they are all completed
- Levofloxacin 500 mg IV
- C & S of the wound
- 0.45% NaCl @ 50 mL/hr
Explanation
Correct Answer: D) C & S of the wound
The wound culture and sensitivity must be collected before administering the antibiotic (Levofloxacin). If the antibiotic is given first, it will kill or inhibit the bacteria present in the wound, compromising the accuracy of the culture results and potentially leading to ineffective treatment. This is a critical sequencing priority in infection management. IV fluids and diet are supportive measures and do not carry the same urgency in this clinical context.
A patient had blood drawn for coagulation studies. The result is critically high. What action should take place at this time?
- The nurse should notify the health care provider whenever they arrive on the unit.
- The laboratory technician should notify the health care provider of the result.
- The nurse should call the health care provider with the result.
- The laboratory technician should repeat the test for verification.
Explanation
Correct Answer: C) The nurse should call the health care provider with the result.
Critically high coagulation study results require immediate notification of the health care provider by the nurse — this is a patient safety priority. Critical lab values must be communicated promptly and directly, not delayed until the provider arrives on the unit. While the lab technician reports results to the nurse, it is the nurse's professional responsibility to act on critical values and contact the provider immediately. Repeating the test causes dangerous delays in a critical situation.
What abnormal characteristics should be reported after obtaining a urine sample? (Select all that apply.)
- Light amber color
- Yellow color
- Slight musty odor
- Blood-tinged
- Presence of sediment
- Cloudiness of urine
Explanation
Correct Answers: C) Slight musty odor, D) Blood-tinged, E) Presence of sediment, and F) Cloudiness of urine
Normal urine is pale to medium yellow in color, clear, and has a mild characteristic odor. Light amber and yellow are both within the spectrum of normal urine color and do not require reporting. A musty or foul odor, blood-tinged appearance (hematuria), sediment, and cloudiness are all abnormal findings that may indicate infection, kidney disease, dehydration, or other pathology and must be reported and documented promptly.
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