Specimen Collection
Help Questions
NCLEX-PN › Specimen Collection
The practical nurse (PN) is reinforcing instructions for a female client on how to collect a clean-catch midstream urine specimen. Which statement by the client indicates that the teaching has been effective?
I need to hold my labia apart while I urinate into the cup.
I will clean the area with the provided wipes, moving from back to front.
I should start urinating directly into the cup as soon as I begin.
I will fill the container to the very top with urine.
Explanation
The correct procedure for a female client collecting a clean-catch midstream urine specimen is to separate the labia to prevent contamination from the surrounding skin and then urinating. Wiping from back to front can introduce bacteria into the meatus. The client should urinate a small amount into the toilet first (midstream) to clear the urethra. The container only needs to be filled to the level indicated, not to the top.
A 24-hour urine collection is ordered for a client. The PN begins the collection at 8:00 AM. Which action should the PN take first?
Tell the client to limit fluid intake during the 24-hour collection period.
Collect the client's first voided specimen at 8:00 AM and place it in the container.
Instruct the client to void at 8:00 AM, discard the specimen, and then begin the collection.
Keep the collection container at room temperature at the client's bedside.
Explanation
To start a 24-hour urine collection, the client should empty their bladder, and that first specimen is discarded. This ensures the collection begins with an empty bladder. The time is noted, and all subsequent urine for the next 24 hours is collected. The container must be kept on ice or refrigerated, and the client should be encouraged to maintain normal fluid intake unless otherwise specified.
The PN is collecting a stool specimen for a guaiac test (fecal occult blood test). Which action is a necessary part of the procedure?
Obtain a sample from two different areas of the stool specimen.
Ensure the specimen is refrigerated immediately after collection.
Instruct the client to urinate into the collection container with the stool.
Use a large amount of stool to completely cover the test card window.
Explanation
When collecting a stool specimen for a guaiac test, a small sample should be taken from two different parts of the stool because occult blood may not be distributed evenly throughout the specimen. The specimen should be free of urine. Only a thin smear of stool is needed on the test card. Refrigeration is not required for this specific test card method.
A sputum specimen for culture and sensitivity is ordered for a client with pneumonia. To ensure a high-quality specimen, the PN should plan to collect it at what time?
Immediately after the client finishes breakfast.
After the client has used an antiseptic mouthwash.
In the early morning, shortly after the client awakens.
In the evening, just before the client goes to sleep.
Explanation
Sputum specimens are best collected in the early morning because secretions pool in the airways overnight, making it easier to obtain a sample rich in microorganisms. The client should rinse their mouth with water, not antiseptic mouthwash, to reduce contamination from mouth flora. Collecting after a meal can increase the risk of emesis and contamination with food particles.
The PN is preparing to obtain a culture from a client's wound that has purulent drainage. Which is the first step in the collection process?
Cleanse the wound with sterile normal saline.
Gently swab the most purulent drainage in the wound bed.
Remove the old dressing and immediately swab the visible drainage.
Swab the skin around the wound edges.
Explanation
Before collecting a wound culture, the wound should be cleansed or irrigated with a non-antiseptic solution like sterile normal saline. This removes surface contaminants and old drainage, ensuring the specimen collected reflects the microorganisms actually causing infection within the wound tissue. Swabbing pus, old drainage, or periwound skin can result in an inaccurate culture.
The PN needs to collect a sterile urine specimen from a client with an indwelling urinary catheter system. What is the correct action?
Cleanse the specimen port on the tubing and aspirate urine with a sterile syringe.
Disconnect the catheter from the drainage tubing and collect urine.
Ask the client to void into a sterile collection cup.
Empty urine from the drainage bag into a sterile container.
Explanation
To obtain a sterile specimen from an indwelling catheter, the PN must use aseptic technique. This involves cleansing the designated specimen port with an antiseptic wipe and using a sterile syringe to aspirate urine. Disconnecting the system or collecting from the bag introduces a high risk of contamination. The client cannot void normally while the catheter is in place.
When performing a capillary blood glucose test, which action by the PN demonstrates correct technique?
Vigorously milking the client's finger to obtain a larger sample.
Wiping away the first drop of blood with sterile gauze.
Using the client's index finger because it is the most accessible.
Puncturing the center of the client's fingertip.
Explanation
The first drop of blood from a capillary puncture contains interstitial fluid and tissue debris, which can alter the blood glucose reading. Therefore, it should be wiped away. The puncture should be on the side of the fingertip, not the center, as it is less painful and has better blood flow. The finger should be gently squeezed, not milked, as milking can also introduce interstitial fluid. The middle or ring finger is preferred over the index finger, which tends to have thicker calluses.
To ensure client safety and accuracy of results, when is the correct time for the PN to label a specimen container?
At the nurses' station before entering the client's room.
Before handing the specimen to the unlicensed assistive personnel (UAP) for transport.
After confirming the results with the primary health care provider.
At the client's bedside immediately after collecting the specimen.
Explanation
Labeling the specimen at the client's bedside immediately after collection is a critical safety step. It confirms the specimen belongs to the correct client (using two identifiers) and minimizes the risk of mislabeling or mix-ups. Labeling before collection is risky because the plan might change or the wrong label could be used. Labeling at the nurses' station increases the risk of error.
The PN is attempting to collect a sputum specimen from an older adult client who is weak and unable to produce a strong cough. Which action should the PN take first?
Offer the client a warm beverage to help loosen secretions.
Document in the chart that the specimen could not be obtained.
Encourage the client to take several deep breaths and then try to cough again.
Notify the RN that the client may require nasotracheal suctioning.
Explanation
The least invasive action should be attempted first. Encouraging the client to take deep breaths can help mobilize secretions and facilitate a more effective cough. Offering a warm beverage may also help, but deep breathing is a more direct first intervention. Notifying the RN for suctioning is appropriate if simpler measures fail. Documentation occurs after all attempts are made.
While collecting a routine urine specimen, the PN observes that the urine is dark, cloudy, and has a strong, foul odor. What is the most appropriate action for the PN to take?
Discard the specimen, as it is likely contaminated.
Send the specimen to the laboratory and document the findings in the chart.
Ask the client if they have been drinking enough fluids.
Report the characteristics of the urine to the registered nurse (RN).
Explanation
The PN's role is to collect data and report abnormal findings. Dark, cloudy, foul-smelling urine is an abnormal finding that suggests dehydration and/or a urinary tract infection. The PN should report this data to the RN, who can then perform a full assessment and collaborate with the health care provider. While the PN will send the specimen and document, the priority is to communicate the abnormal finding.