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 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 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.
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.
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.
The nurse observes the UAP obtain a client's blood glucose measurement. Which of the following, if observed, would require correction by the nurse? (Select all that apply.)
-
The UAP milks the client's finger before pressing the release button of the lancet device.
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The UAP cleans the central tip of the finger with an antiseptic swab and allows it to air dry.
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The UAP removes the cover on the tip of the lancet before cocking the lancet device.
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The UAP scrapes the drop of blood onto the test strip and waits for test results.
Explanation
Correct Answers: A) The UAP milks the client's finger before pressing the release button of the lancet device, C) The UAP removes the cover on the tip of the lancet before cocking the lancet device, and D) The UAP scrapes the drop of blood onto the test strip and waits for test results.
Milking the finger before lancing is incorrect — the finger should be warmed and gently squeezed after lancing if needed, as milking before can alter the blood sample and cause inaccurate results. The lancet cover must be removed after cocking the device, not before, to maintain safety and sterility. Blood should be gently touched to the test strip, never scraped, as scraping can damage the strip and produce inaccurate readings. Cleaning with an antiseptic swab and allowing it to air dry is the correct technique.
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.
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.
What are some interventions the nurse can do to help minimize embarrassment for the patient during specimen collection? (Select all that apply.)
-
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.
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.
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