PN 146 01 CONCEPTS OF PRACTICAL Nursing Nightingale
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Free PN 146 01 CONCEPTS OF PRACTICAL Nursing Nightingale Questions
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:
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"This method will prevent you from developing urinary incontinence by strengthening perineal muscles."
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"By catching the middle of the urine stream, it provides time to ensure the bladder is completely empty."
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"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 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.
Which of the following statements, if made by the patient regarding a midstream (clean-voided) urine specimen, indicate that further teaching is required? (Select all that apply.)
- Male patient: "I will clean myself by using the antiseptic towelette, starting at the center going outward in a circular motion."
- "I should first start urinating into the toilet, then use the sterile specimen cup to collect about 3 to 4 ounces of urine, and finish urinating into the toilet."
- "I should wash myself with soap and water, and urinate into the specimen cup."
- "I should urinate 30 to 60 mL into a cup and then finish urinating in the toilet."
- Female patient: "I will clean myself by using the cotton balls and antiseptic solution. I will cleanse moving from front to back using a fresh swab each time, repeating motions 3 times."
- "I should avoid touching the inside of the specimen cup or lid."
Explanation
Correct Answers: B) "I should first start urinating into the toilet, then use the sterile specimen cup to collect about 3 to 4 ounces of urine," C) "I should wash myself with soap and water, and urinate into the specimen cup," and D) "I should urinate 30 to 60 mL into a cup and then finish urinating in the toilet."
Statement B requires correction — the amount of 3 to 4 ounces is excessive; only about 30–60 mL is needed, making statement D also partially correct in volume but the sequence described in B is otherwise acceptable. Statement C requires correction because soap and water alone are insufficient — the antiseptic towelette or solution must be used to properly clean the perineal area. Statement D's volume of 30–60 mL is correct but should be clarified as the midstream portion. The male cleaning technique (A), female front-to-back technique (E), and not touching the inside of the cup (F) all reflect correct understanding and do not require further teaching.
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 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.
Which of the following are indications of a localized wound infection? (Select all that apply.)
- Warmth at wound site
- Purulent drainage
- Fever
- Pain or tenderness at wound site
- Chills
- Excessive thirst
Explanation
Correct Answers: A) Warmth at wound site, B) Purulent drainage, and D) Pain or tenderness at wound site
The classic signs of localized wound infection are the cardinal signs of local inflammation: warmth (calor), redness (rubor), swelling (tumor), pain (dolor), and purulent drainage. These are confined to the wound site itself. Fever and chills are signs of a systemic infection response, not localized infection. Excessive thirst is associated with hyperglycemia or dehydration and is not an indicator of wound infection.
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.
What are some interventions the nurse can do to help minimize embarrassment for the patient during specimen collection? (Select all that apply.)
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Allow the patient to perform as much of the sample collection as appropriate.
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Provide privacy.
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Perform the specimen collection for the patient so you don't have to discuss it.
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Provide written instructions only.
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Have family members assist in the collection process.
Explanation
Correct Answers: A) Allow the patient to perform as much of the sample collection as appropriate, and B) Provide privacy.
Allowing the patient to self-collect as much as possible preserves dignity and reduces embarrassment. Providing privacy is a fundamental nursing responsibility during any intimate procedure. Performing the collection without discussion removes patient autonomy and does not address embarrassment appropriately. Providing written instructions only is insufficient as the patient may need verbal clarification and support. Having family members assist without the patient's explicit consent violates privacy and can increase embarrassment.
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.
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.
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